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The Role of Condition Specific Measures in Economic Evaluation

其他書名	It's a Trade-Off
出版	SSRN, 2007
URL	http://books.google.com.hk/books?id=rMDizwEACAAJ&hl=&source=gbs_api

註釋This paper will consider the arguments for using preference-based CSMs in economic evaluation and the different ways in which this could be done. This paper will consider three arguments for using CSMs: 1) popularity with clinicians, 2) greater sensitivity to the consequences of the condition suffered by patients because they focus on the most important dimensions pertinent to that condition and 3) generic measures may not cover all dimensions of relevance to a condition. It then reviews the main arguments against CSMs: 1) they fail to capture the impact on co-morbidities suffered by patients 2) they fail to take into account side effects of treatment and 3) they fail to achieve comparability across conditions or treatment. In response to the third argument against, it can be argued that comparability is achieved by using the same valuation methods: using the same valuation technique (and variant of the technique) with common anchors (full health and death) obtained from the same type of respondents (such as a representative sample of the general population). This paper will consider the additional assumption, that the impact of different dimensions on preferences is additive, whether or not they are included in the descriptive system. It assumes preference independence between dimensions included in the descriptive system of the specific measure and those dimensions not included. Generating health state values is ultimately a trade-off between using measures that are relevant and sensitive to those things that matter to patients (including side effects) and the potential size of the preference dependence between dimensions. Pragmatically, the importance of preference interactions will not be the same between conditions. Where most patients have one condition or where the condition concerned dominates, then the role of interactions is likely to be more modest. The relative importance of the different arguments in this trade-off will vary between conditions. Whether or not CSMs are thought to have a role in their own right, researchers often find that they only have CSM data for use in economic evaluation. This paper goes onto to contrast the two main alternative methods of using existing, non-preference-based CSM data: mapping between the CSM and an existing generic preference-based measure; and undertaking a valuation of the CSM in its own right (see paper 3).