Individualized cost-effectiveness analysis of patient-centered care: a case series of hospitalized patient preferences departing from practice-based guidelines

William Padula, M. Andrew Millis, Aelaf D. Worku, Peter J. Pronovost, John F P Bridges, David O. Meltzer

Research output: Contribution to journalArticle

Abstract

Objective: To develop cases of preference-sensitive care and analyze the individualized cost-effectiveness of respecting patient preference compared to guidelines. Methods: Four cases were analyzed comparing patient preference to guidelines: (a) high-risk cancer patient preferring to forgo colonoscopy; (b) decubitus patient preferring to forgo air-fluidized bed use; (c) anemic patient preferring to forgo transfusion; (d) end-of-life patient requesting all resuscitative measures. Decision trees were modeled to analyze cost-effectiveness of alternative treatments that respect preference compared to guidelines in USD per quality-adjusted life year (QALY) at a $100,000/QALY willingness-to-pay threshold from patient, provider and societal perspectives. Results: Forgoing colonoscopy dominates colonoscopy from patient, provider, and societal perspectives. Forgoing transfusion and air-fluidized bed are cost-effective from all three perspectives. Palliative care is cost-effective from provider and societal perspectives, but not from the patient perspective. Conclusion: Prioritizing incorporation of patient preferences within guidelines holds good value and should be prioritized when developing new guidelines.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalJournal of Medical Economics
DOIs
StateAccepted/In press - Nov 10 2016

Keywords

  • cost-effectiveness analysis
  • guidelines
  • Patient preferences
  • patient-centered care

ASJC Scopus subject areas

  • Health Policy

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