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Medical Decision Making
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Incorporating Extrinsic Goals Into Decision and Cost-Effectiveness Analyses

Gordon B. Hazen, PhD

Department of Industrial Engineering and Management Sciences, Northwestern University, Evanston, Illinois, hazen{at}iems.northwestern.edu

Alan Schwartz, PhD

Department of Medical Education, University of Illinois, Chicago

It has not been widely recognized that medical patients as individuals may have goals that are not easily expressed in terms of quality-adjusted life years (QALYs). The QALY model deals with ongoing goals such as reducing pain or maintaining mobility, but goals such as completing an important project or seeing a child graduate from college occur at unique points in time and do not lend themselves to easy expression in terms of QALYs. Such extrinsic goals have been posited as explanations for preferences inconsistent with the QALY model, such as unwillingness to trade away time or accept gambles. In this article, the authors examine methods for including extrinsic goals in medical decision and cost-effectiveness analyses. As illustrations, they revisit 2 previously published analyses, the management of unruptured intracranial arteriovenous malformations (AVMs) and the evaluation of preventive strategies for BRCA + women.

Key Words: theories of quality of life • utility inconsistencies • utility measurement • multiattribute utility function • health state preferences • utilities • and valuations • health-related quality of life • cancer prevention.

This version was published on September 1, 2009

Medical Decision Making, Vol. 29, No. 5, 580-589 (2009)
DOI: 10.1177/0272989X09333121
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