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Individualized cost-effectiveness analysis of patient-centered care: a case series of hospitalized patient preferences departing from practice-based guidelines |
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| Authors: | William V Padula M Andrew Millis Aelaf D Worku Peter J Pronovost John F P Bridges David O Meltzer |
| Institution: | 1. Department of Health Policy &2. Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;3. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA;4. Section of Hospital Medicine, University of Chicago, Chicago, IL, USA;5. CareMore Health Plan, Las Vegas, NV, USA;6. Departments of Anesthesiology, Critical Care and Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA;7. Center for Health and the Social Sciences (CHeSS), University of Chicago, Chicago, IL, USA |
| 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. |
| Keywords: | Patient preferences patient-centered care guidelines cost-effectiveness analysis |