Article

OBJECTIVE: To examine how the time tradeoff (TTO) and standard gamble (SG)
utilities perform at different lengths of life expectancy and across patient
characteristics such as risk attitudes and injury severity in individuals with
traumatic spinal cord injury (SCI). DESIGN: Survey. SETTING: Structured telephone
interviews of patients after discharge from 4 teaching hospitals. PARTICIPANTS:
Subjects (N=270) who had sustained SCI were block-randomized in groups of 4 to
receive 1 of 2 questionnaire versions. One version asked about the TTO and SG at
2 life expectancies of 10 and 20 years, and the other at 20 and 30 years.
INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The TTO and SG were used to
elicit preferences for patients with an SCI. RESULTS: Patients with SCI who were
younger and had more severe neurologic lesions, had higher intense risk-taking
attitudes, and experienced depression had significantly lower TTO and SG scores
than their counterparts. A longer life expectancy was also significantly
associated with lower TTO scores. As the life expectancy increased, patients who
had sustained SCI more recently (</=1 y ago) were more willing to trade off life
years for full health (ie, lower TTO scores). SG scores did not significantly
vary according to different life expectancies. CONCLUSIONS: Among patients with
SCI, there was a nonlinear relation between the TTO and life expectancy that
violated the fundamental assumption of risk neutrality toward life years.
Accordingly, TTO utilities elicited for different life expectancies should not be
compared in quality-of-life assessments or used in cost-utility analyses. In
contrast, SG utilities remained stable at different lengths of life expectancy in
SCI patients. Moreover, certain patient characteristics such as age, time lapse
since the injury, neurologic severity, risk attitudes, and depressive status can
account for some TTO and SG variations among patients with SCI.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS