Should We Account for Variation in Patient Preferences in Health Technology Assessment? Individual Preferences With Respect to the Characteristics and Possible Outcomes of a Healthcare Intervention May Vary

ISSUE: Individual preferences with respect to the characteristics and possible outcomes of a healthcare intervention may vary. Some patients may have a preference for maximising the probability of response to treatment, whereas others may have a preference for avoiding certain adverse events. Some patients may have a preference to avoid injections, whereas others may wish to avoid frequent oral medication.

However, the standard decision rules for cost-effectiveness analysis identify a single technology as maximising expected health benefit. Decisions made on this basis may fail to recognise variation in preferences and circumstance and be economically inefficient failing to maximise patient utilities, compromise treatment adherence, and worsen health inequalities.

In this issue panel we will explore how heterogeneity in individual preferences might be investigated using qualitative and quantitative methods, including elicitation of personal utility functions, and accounted for in decision-making in terms of deliberation and ‘decision-rules’.

OVERVIEW: Ben Van Hout will discuss evolving methods to solicit more accurate estimates of utility weights using personal utility functions and their potential use in decision-making.

Neil Hawkins will moderate and will provide context by exploring how the ‘rules’ of cost-effectiveness analysis might be adapted to account for preference heterogeneity including the role of cost-minimisation, net-benefit, and ‘individualised cost-effectiveness” approaches.

Shelagh Szabo will describe methodologies that have been used to explore heterogeneity in patient preferences. These include qualitative methods using grounded theory and quantitative methods such as discrete choice experiments with latent class analysis.

Amanda Adler, as a clinician and an ex-chair of a NICE technology appraisal committee, will moderate and share her experiences in considering heterogeneity in preferences in real-world decision making. We will use real-time polling to allow the audience to express their own heterogeneity in preferences with respect to this topic and to allow the audience to act as a reimbursement ‘decision-maker’.