states worse than dead

No, this isn’t another moan by yours truly about how the valuation people deal (in)correctly with states worse than the death on in health economics valuation exercises (phew).

This tweet interested me.  There are all sorts of things you could do with a discrete choice experiment (DCE) to measure the trade-offs such patients make. When at UTS, we did a DCE that did two things, one novel and one not so novel. The first was an attitudinal one that found there are three segments among Australian retired people (our sample was around 1100 total) when you got them to tell you what statements about life they related to most and least – Best-Worst Scaling. We did something never done before – feed back to them their own results after that survey that they could print off, bring to their doctor to discuss, use as the starting point for and end-of-life care plan etc: results of this form a chapter in the book referenced. Of course the doctors at the sharp end in ICUs had warned us that thanks to TV programmes the general public has much higher expectations about the success/acceptablility of these dramatic interventions than is true in practice, but you could do the same survey with patients. In fact the bare bones of the survey are still live at the link and you can see how you compare with older Aussies.

The second DCE was (by DCE standards) very very simple, but was done to get a handle on the trade-offs people woul make regarding the kinds of interventions in the survey in this Twitter post and unfortunately won’t give you personalised results.

These types of DCEs should become routine. They can be done on touchscreen tablet PCs etc when the patient is waiting to see the doctor, they can give personalised results – not aggregated ones like in the bad old days. People like them, and like to know how they compare with others – the older generation love those surveys comparing them to others just as much as the younger “Facebook generations”. C’mon people, this survey is great and very very informative but we can move forward even further and do it today.