Eliciting health state utilities for Dupuytren’s contracture using a discrete choice experiment

摘要

Background and purpose An internet-based discrete choiceudexperiment (DCE) was conducted to elicit preferences for a wideudrange of Dupuytren’s contracture (DC)-related health states. Anudalgorithm was subsequently developed to convert these preferencesudinto health state utilities that can be used to assess DC’sudimpact on quality of life and the value of its treatments.udMethods Health state preferences for varying levels of DCudhand severity were elicited via an internet survey from a sampleudof the UK adult population. Severity levels were deined using audcombination of contractures (0, 45, or 90 degrees) in 8 proximaludinterphalangeal and metacarpophalangeal joints of the index,udmiddle, ring, and little ingers. Right-handed, left-handed, andudambidextrous respondents indicated which hand was preferableudin each of the 10 randomly-selected hand-pairings comparinguddifferent DC severity levels. For consistency across comparisons,udanatomically precise digital hand drawings were used. To anchorudpreferences onto the traditional 0–1 utility scale used in healthudeconomic evaluations, unaffected hands were assigned a utilityudof 1.0 whereas the utility for a maximally affected hand (i.e., allud8 joints set at 90 degrees of contracture) was derived by askingudrespondents to indicate what combination of attributes and levelsudof the EQ-5D-5L proile most accurately relects the impact ofudliving with such hand. Conditional logistic models were used toudestimate indirect utilities, then rescaled to the anchor points onudthe EQ-5D-5L.udResults Estimated utilities based on the responses of 1,745udqualiied respondents were 0.49, 0.57, and 0.63 for completelyudaffected dominant hands, non-dominant hands, or ambidextrousudhands, respectively. Utility for a dominant hand with 90-degreeudcontracture in t h e metacarpophalangeal joints of the ring andudlittle ingers was estimated to be 0.89. Separately, reducing theudcontracture of metacarpophalangeal joint for a little inger fromud50 to 12 degrees would improve utility by 0.02.udInterpretation DC is associated with substantial utility decrements.udThe algorithms presented herein provide a robust and lexibleudframework to assess utility for varying degrees of DC severity. ud