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PURPOSE: To examine differences in the valuation of health states by patients and community members from different ethnic backgrounds.
METHODS: We surveyed 193 community members identified by random digit dialing: 64 white (W), 65 African-American (AA) and 64 Hispanic (H). The patient sample included 198 individuals diagnosed with osteoarthritis (OA) and drawn sequentially from a health-provider institution clinic lists, 66 per ethnic group. Participants were interviewed face to face and asked to rate two different scenarios describing patients with arthritis (mild and severe) using visual analog scale (VAS), standard gamble (SG) and time trade-off (TTO). Differences were adjusted for cohort, age, age-squared, gender, and education.
RESULTS: The difference between the utility scores for mild OA and severe OA was significantly smaller for AA than W by the VAS, TTO, and SG methods. The difference between mild and severe states was smaller for H than W by the SG method. For the severe OA state the odds that AA had scores > 0.80 relative to W was 2.22 using the TTO method. Preferences for the mild OA state were not different among ethnic groups. Using the SG method, the odds that the scores were > 0.80 in the public cohort vs. the patient cohort were greater than 1 for severe OA and for mild OA. The public gave the severe OA state a higher preference score than patients did using the VAS method. Education and age had significant, independent effects on utility scores. Age increased the SG utility scores, and the difference between severe and mild health states was less by VAS for older individuals. Education ameliorated the effects of other variables on TTO and SG scores.
CONCLUSIONS: Our findings show significant differences between ethnic groups in the valuation of health, with AA reporting less difference between the mild OA state and the severe OA state than W by the VAS, TTO and SG methods of valuating health states. H were less willing than W to risk death to move from a severe OA state to a mild OA state. Members of the public were less willing than patients to risk death to achieve perfect health. These differences suggest that in health decision-making, valuation of health states cannot be used interchangeably across ethnic groups.
See more of Poster Session - Utility Theory; Health Economics; Patient & Physician Preferences; Simulation; Technology Assessment
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)