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Obtaining Utility Estimates of the Health Value of Commonly Prescribed Treatments for Asthma and Depression

RAND Health, Santa Monica, California, Maria_Edelen{at}rand.org

M. Audrey Burnam, PhD

RAND Health, Santa Monica, California

Katherine E. Watkins, MD, MSHS

RAND Health, Santa Monica, California

José J. Escarce, MD, PhD

RAND Health, Santa Monica, California

Haiden Huskamp, PhD

Harvard Medical School, Department of Health Care Policy, Cambridge, Massachusetts

Howard H. Goldman, MD, PhD

Department of Psychiatry, University of Maryland School of Medicine, Baltimore

Gary Rachelefsky, MD

Allergy Research Foundation, Inc., Los Angeles, California, Division of Allergy and Immunology, University of California, Los Angeles

Background. Comparing the costs and health value associated with alternative quality improvement efforts is useful. This study employs expert panel methodology to elicit numerical estimates based on a 0 to 1 utility scale of the health benefit of usual treatment patterns for 2 medical conditions. Method. The approach includes development of clinical profiles and derivation of treatment benefit estimates via the elicitation of utility ratings before and after treatment. Clinical profiles specified characteristics of patient groups, treatments to be rated, and their combinations. A panel of 13 asthma and depression experts made a series of utility ratings (before any new treatment, 1 or 3 mo later with no treatment, 1 or 3 mo after initiating various common treatments) for adult patient groups with depression or asthma. The panel convened to discuss discrepancies and subsequently made final ratings. Treatment benefit estimates were derived from the ratings made by the panelists after the panel meeting. Results. The treatment benefit estimates had face validity and minimal variability, indicating considerable consensus among experts. Treatment benefit estimates ranged from –0.03 to 0.25 for depression and from –0.04 to 0.24 for asthma. There was minimal variation in the estimates for both conditions (the estimates' standard deviations ranged from 0.01 to 0.06). Comparisons of the treatment benefit estimates before and after the expert panel meeting indicated substantial convergence, and evidence suggests that the benefit estimates are comparable across the 2 health conditions. Conclusion. Comparable estimates of treatment benefit for distinct health conditions can be obtained from experts using the expert panel methodology.

Key Words: Key words: expert panel • consensus panel • health value • treatment benefit • depression • asthma.

This version was published on September 1, 2008

Medical Decision Making, Vol. 28, No. 5, 732-750 (2008)
DOI: 10.1177/0272989X08315251


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