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Incorporating Process Utility into Cost-Effectiveness Analysis via a Bolt-On Domain to the SF-6D: An Exploratory Study

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Abstract

Background

Within the UK, standard methods of economic evaluation centre on the maximisation of the quality-adjusted life-year (QALY). However, preference-based measures used to estimate QALYs may not be suited to all economic evaluations, as they routinely measure only health outcomes.

Aim

This study used an economic evaluation alongside a clinical trial (EEACT) comparing patients’ preferences for a telephone versus a face-to-face consultation to incorporate process utility into cost-effectiveness analyses.

Methods

An EEACT is described that generates QALYs using Short-form 6-dimension version 1 (SF-6Dv1) responses. These results exclude specific consideration of process utility. A health state valuation study is then reported that bolts a process domain onto the SF-6Dv1 using data obtained from the EEACT. These results therefore include the consideration of process utility. The results of the EEACT with and without process utility are then compared.

Results

This study shows that the QALY, in its current form, does not capture patient benefits associated with the process of receiving healthcare. The EEACT illustrates this, showing a statistically significant difference between control and intervention groups for the patient experience questionnaire communication domain, indicating that patients preferred the intervention. This preference was not identified in the cost-effectiveness outcomes, and the point estimates lie in the north-west quadrant of the cost-effectiveness plane. The preference is captured after adding a communication domain. The point estimate moves to the north-east quadrant, where the intervention is more effective and more costly than the control.

Conclusion

This study indicates that it is possible to capture patients’ preferences for processes associated with care, in a format compatible with the QALY.

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Acknowledgements

The authors thank the reviewers for their comments on the draft manuscript.

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Authors and Affiliations

  1. Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK

    Victoria K. Brennan & Simon Dixon

  2. Faculty of Health and Social Sciences, Leeds Beckett University, Calverley Building, City Campus, Leeds, UK

    Georgina Jones

  3. Jessop Wing, Sheffield Teaching Hospitals NHS Trust and Honorary Senior Lecturer, University of Sheffield, Jessop Wing, Tree Root walk, Sheffield, UK

    Stephen Radley

Authors
  1. Victoria K. Brennan
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  2. Georgina Jones
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  3. Stephen Radley
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  4. Simon Dixon
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Corresponding author

Correspondence to Victoria K. Brennan.

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Funding

This work was partially funded by RTI Health Solutions through a supporting PhD fund. Funding for the online survey was obtained from The University of Sheffield, School of Health and Related Research data collection fund.

Conflict of Interest

S Radley is an unsalaried director and shareholder in ePAQ Systems Ltd, a UK national health service (NHS) spin-out technology company, the largest shareholder in which is Sheffield Teaching Hospitals NHS Foundation. VK Brennan, S Dixon, G Jones and S Radley have no conflicts of interest that are directly relevant to the content of this article.

Availability of data and material

Information on the availability of data from the ePAQ EEACT is reported within the relevant publication [6]. For the bolt-on study, ethics approval and patient consent were gained only for results to be shared through publications in academic journals and presented at conferences and can only be published in aggregate form. These data sets are therefore not publicly available. Data enquiries may be directed to the corresponding author.

Ethics approval

The EEACT study protocol was approved by the North Sheffield ethics committee and was registered at www.clinicaltrials.gov (identifier NCT02176330). The process utility valuation study gained ethics approval from The University of Sheffield ethics committee.

Informed consent

Informed consent to participate in the study was obtained from all participants.

Code availability

Coding from the analyses can be obtained from the authors on request. This includes the STATA files for the SUR analyses and production of the cost-effectiveness planes and CEACs, and in SPSS format for the regression analyses run. Coding enquiries may be directed to the corresponding author.

Author contributions

VB was involved in study conception and design, data collection, and analysis and interpretation of results and drafted the manuscript. SD was involved in the study conception and design and advised on the analysis and interpretation of results. GJ and SR led the EEACT. All authors reviewed the results and approved the final version of the manuscript.

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Brennan, V.K., Jones, G., Radley, S. et al. Incorporating Process Utility into Cost-Effectiveness Analysis via a Bolt-On Domain to the SF-6D: An Exploratory Study. Appl Health Econ Health Policy 19, 747–756 (2021). https://doi.org/10.1007/s40258-021-00646-4

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  • DOI: https://doi.org/10.1007/s40258-021-00646-4

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