Validity of standard gamble utilities in patients referred for aortic valve replacement
Standard gamble (SG) is the preferred method of assessing preferences in situations with uncertainty and risk, which makes it relevant to patients considered for aortic valve replacement (AVR). The present study assesses SG preferences in patients with severe aortic stenosis (AS).
All patients >18 years old with severe AS referred for AVR to our institution were invited to enroll in the study. The SG was administered by a clinical research nurse. The SF-36, EQ-5D 3L, Hospital Anxiety and Depression Scale (HADS), and AS symptoms were administered by self-completed questionnaire. We hypothesized that SG utilities would have low-to-moderate correlations with physical and mental aspects of health based on our pathophysiological understanding of severe AS. No correlations were expected with echocardiographic measures of the aortic valve.
The response rate for SG was 98 %. SG moderately correlated with physical aspects of SF-36 (PCS, role-physical, vitality), health transition, AS symptoms, and EQ-VAS (ρ S = 0.31–0.39, p < 0.001) and had low correlation with mental aspects of SF-36 and EQ-5D (ρ S = 0.17–0.28, p < 0.001). No correlation was found between SG and HADS, echocardiographic measures, age, gender, or education level (ρ S = 0.01–0.06).
SG is an acceptable and feasible method of assessing preferences in patients with severe AS that has evidence for validity. The inclusion of uncertainty lends the SG face validity in this population as a direct approach to assessing preferences and basis for QALY calculations.
KeywordsStandard gamble Validity Utility Patient preferences Patient-reported outcomes Aortic valve replacement
Dr. A. Hussain is the recipient of a research fellow from the Norwegian Health Association.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in the study were in accordance with the ethical standards of the local research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
- 8.Drummond, M. F., et al. (2005). Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press.Google Scholar
- 13.Ware, J. E., Kosinski, M., & Dewey, J. E. (2000). How to score version 2 of the SF-36 health survey: (standard & acute forms). Lincolm, RI: QualityMetric Inc.Google Scholar
- 27.New York Heart Association Criteria, C. (1979). Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. Boston: Little, Brown.Google Scholar
- 28.Lang, R. M., et al. (2005). Recommendations for chamber quantification: A report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Journal of the American Society of Echocardiography, 18(12), 1440–1463.CrossRefPubMedGoogle Scholar
- 29.Quinones, M. A., et al. (2002). Recommendations for quantification of Doppler echocardiography: A report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. Journal of the American Society of Echocardiography, 15(2), 167–184.CrossRefPubMedGoogle Scholar
- 35.Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Laurence Erlbaum.Google Scholar
- 49.Reynolds, M. R., et al. (2012). Cost-effectiveness of transcatheter aortic valve replacement compared with surgical aortic valve replacement in high-risk patients with severe aortic stenosis: Results of the PARTNER (Placement of Aortic Transcatheter Valves) trial (Cohort A). Journal of the American College of Cardiology, 60(25), 2683–2692.CrossRefPubMedGoogle Scholar