OBJECTIVES

The QALY approach has been criticized due to several limitations, among others, due to the narrow definition of Health Related Quality of Life (HRQoL), which is mostly centered in patient symptoms. The VALY approach intends to span the HRQoL scope, including other aspects of patient needs and wellbeing to assess the impact of health treatments. The aim of this work is to assess if differences exist between health experts and patients in their valuations of the different attributes and dimensions included in the VALY definition.

METHODS

After content selection of health dimensions and attributes extracted through a systematic literature review and set of 6 dimensions (# attributes) were identified: physical symptoms (9), affective symptoms, (8), mental symptoms (4), personal and social wellbeing (8), treatment satisfaction (7) and treatment experience (4). Two expert samples were recruited composed by 23 health consultants and 13 chronic kidney patients. Attributes within a dimension were valued with attribute scores adding to 100. Dimensions were ranked from most to less important. Average attribute scores were used assess dimensionality (factor analysis), attribute discrimination (mixed effects variance components) and discriminant validity (repeated measures ANOVA).

RESULTS

For the physical symptom dimension, differences were found between attribute valuations within each dimension (p<0.001), between expert groups (p<0.012) and the interaction of both factors (p<001). Similar results were found for other dimensions. The ranking of dimensions differed between expert groups, but only for the less important dimensions: treatment satisfaction (p<0.001) and treatment experiences (p<0.001).

CONCLUSIONS

Although agreement between health consultants and patients was observed for the better valued attributes and dimensions, differences were also found which conveys to discuss how trustworthy could instruments be when not considering patient values and opinions from the very beginning on instrument development.