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

Fingerprint

Patient-Centered Care
Patient Preference
Practice Guidelines
Cost-Benefit Analysis
Guidelines
Colonoscopy
Quality-Adjusted Life Years
Air
Costs and Cost Analysis
Decision Trees
Palliative Care

Keywords

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

ASJC Scopus subject areas

  • Health Policy

Cite this

Individualized cost-effectiveness analysis of patient-centered care : a case series of hospitalized patient preferences departing from practice-based guidelines. / Padula, William; Millis, M. Andrew; Worku, Aelaf D.; Pronovost, Peter J.; Bridges, John F P; Meltzer, David O.

In: Journal of Medical Economics, 10.11.2016, p. 1-9.

Research output: Contribution to journalArticle

Padula, William ; Millis, M. Andrew ; Worku, Aelaf D. ; Pronovost, Peter J. ; Bridges, John F P ; Meltzer, David O. / Individualized cost-effectiveness analysis of patient-centered care : a case series of hospitalized patient preferences departing from practice-based guidelines. In: Journal of Medical Economics. 2016 ; pp. 1-9.
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