Objective: Assigning utilities to hypothetical health states requires that the health states be described in adequate detail, but there is no agreement on exactly how health states should be described. We assessed utilities for health states common in scleroderma (SSc) by describing the health states in writing alone vs. with pictures of patients with SSc.

Methods: Subjects, recruited through flyers and advertisements, completed computer-assisted rating scale (RS; range, 0-100), time trade-off (TTO; range: 0.0-1.0) and standard gamble (SG; range: 0.0-1.0) utility assessments for several SSc health states derived from the Quality of Well-being scale. Each subject assessed 3 of the following 5 SSc health states: mild SSc, moderate SSc, severe SSc, moderate SSc with lung disease, and severe SSc with lung disease. To assess the potential impact on health state valuations of photographs of patients with SSc, half the randomly selected subjects were shown photographs of SSc health states. We performed multivariable regression analyses to determine the effect of the photographs on health state valuations, controlling for subjects' demographics, health status, and valuations of their own health.

Results: A total of 218 adults completed the study; 135 (62%) were female, 143 (66%) were Caucasian, and 62 (28%) were African-Americans. Median RS, TTO, and SG scores for 5 SSc health states ranged from 20-70, 0.28-0.94; and 0.50-0.90, respectively. In univariate analysis, the photographs were associated with lower RS scores for 2 of 5 health states (P<0.05) and lower SG values for all 5 health states (Table), but with no difference in TTO values. Multivariable analyses revealed statistically significant negative associations between pictures and SG valuations for 3 of the 5 SSc health states (moderate SSc with lung disease, severe SSc, severe SSc with lung disease); other significant independent variables included demographics, health status scores, and valuation for their own health (R² range: 0.11-0.32).

Conclusion: Showing photographs of people with SSc can affect valuations of SSc health states, although the effect differs by valuation measurement method.

 

P< 0.05 for all