Elicitation of utility scores in Canada for immune thrombocytopenia treated with romiplostim or watch and rescue

Figures & data

Table 1.  Health states included in the study and associated ranking based on severity.

#	Health state name	Rank*
1	Responders to romiplostim—No or Mild Dry Bleeding (w/AEs other than bleeds)	1
2	Responders to W&R—No or Mild Dry Bleeding (w/AES other than bleeds)	1
3	Responders to romiplostim or W&R—Mild Other Bleeding/Moderate Dry Bleeding (w/out AEs other than bleeds)	2
4	Responders to romiplostim—Mild Other Bleeding/Moderate Dry Bleeding (w/AEs other than bleeds)	3
5	Responders to W&R—Mild Other Bleeding/Moderate Dry Bleeding (w/AEs other than bleeds)	3
6	Non-responders to romiplostim or W&R—No or Mild Dry Bleeding (w/out AEs other than bleeds)	4
7	Non-responders to romiplostim—No or Mild Dry Bleeding (w/AEs other than bleeds)	5
8	Non-responders to W&R—No or Mild Dry Bleeding (w/AEs other than bleeds)	5
9	Non-responders to romiplostim or W&R—Mild Other Bleeding/Moderate Dry Bleeding (w/out AEs other than bleeds)	6
10	Non-responders to romiplostim—Mild Other Bleeding/Moderate Dry Bleeding (w/AEs other than bleeds)	7
11	Non-responders to W&R—Mild Other Bleeding/Moderate Dry Bleeding (w/AEs other than bleeds)	7
12	Significant bleeding	8

*1 = Least severe, 8 = Most severe; Health states sharing the same rank were considered of the same severity by a panel of clinicians.

AEs, adverse events; W&R, watch and rescue; w/, with; w/out, without.

Table 2.  Summary description by health states of treatment and percentage of subjects experiencing side-effects.

HS*	Treatment (type)	Treatment (administration)	Treatment response	Side effects (on 100 people under treatment)
1	Under the skin injection every week	By yourself or by a nurse at home	Success, no bleeding	22 joint pain, 14 diarrhea, and 11 nausea
2	Pills up to 8 weeks or vein injection over 1 or 2 days. Treatment may be repeated	Vein injection in hospital clinic	Success, no bleeding	8 joint pain, 6 diarrhea, and 4 nausea
3	Under the skin injection every week, or pills up to 8 weeks, or vein injection over 1 or 2 days. Treatment may be repeated	By yourself or by a nurse at home, or vein injection in hospital clinic	Success, but bleeding (bruising or pinpoints red dots, blood blisters, or mild bleeding episodes)	None
4	Under the skin injection every week	By yourself or by a nurse at home	Success, but bleeding (bruising or pinpoints red dots, blood blisters, or mild bleeding episodes)	22 joint pain, 14 diarrhea, and 11 nausea
5	Pills up to 8 weeks or vein injection over 1 or 2 days. Treatment may be repeated	Vein injection in hospital clinic	Success, but bleeding (bruising or pinpoints red dots, blood blisters, or mild bleeding episodes)	8 joint pain, 6 diarrhea, and 4 nausea
6	Under the skin injection every week, or pills up to 8 weeks or vein injection over 1 or 2 days. Treatment may be repeated	By yourself or by a nurse at home, or vein injection in hospital clinic	No success, no bleeding	None
7	Under the skin injection every week	By yourself or by a nurse at home	No success, no bleeding	22 joint pain, 14 diarrhea, and 11 nausea
8	Pills up to 8 weeks or vein injection over 1 or 2 days. Treatment may be repeated	Vein injection in hospital clinic	No success, no bleeding	8 joint pain, 6 diarrhea, and 4 nausea
9	Under the skin injection every week, or pills up to 8 weeks, or vein injection over 1 or 2 days. Treatment may be repeated	By yourself or by a nurse at home, or vein injection in hospital clinic	No success, and bleeding (bruising or pinpoints red dots, blood blisters, or mild bleeding episodes)	None
10	Under the skin injection every week	By yourself or by a nurse at home	No success, and bleeding (bruising or pinpoints red dots, blood blisters, or mild bleeding episodes)	22 joint pain, 14 diarrhea, and 11 nausea
11	Pills up to 8 weeks or vein injection over 1 or 2 days. Treatment may be repeated	Vein injection in hospital clinic	No success, and bleeding (bruising or pinpoints red dots, blood blisters, or mild bleeding episodes)	8 joint pain, 6 diarrhea, and 4 nausea
12	Under the skin injection every week, or pills up to 8 weeks, or vein injection over 1 or 2 days. Treatment may be repeated	By yourself or by a nurse at home, or vein injection in hospital clinic	No success, and bleeding external (nose bleeds, bleeding cuts, vaginal bleeding) or internal (bleeding in urine stools or brain) ≥5–15 hospitalization days	None

*For every HS: Blood condition inducing platelet count below normal levels, with a risk of suffering from abnormal bleeding.

HS, Health State.

Note: For descriptions of health states, please see Table 1.

Table 3.  Reporting by health state of percentage of subjects experiencing any feeling, difficulty, or interference of some sort due to their condition.

HS	Feeling/Activity and incidence (out of 100)
	Difficulty to fall asleep	Feeling worn out	Feeling unattractive	Condition negatively interfering with normal social activities	Condition negatively interfering with job promotions	Fear of losing one’s job	Condition negatively interfering with normal physical or sporting activities	Having heavier periods or vaginal bleeding	Condition negatively interfering with relationships with coworkers
1	52	48	29	67	20	18	26	27	–
2	67*	67*	67*	33*	–	100*	33*	100*	–
3	100*	–	50*	75*	–	–	33*	50*	50*
4	67	33	83	29	100	100	29	–	100
5	67*	67*	83*	50*	–	50*	50*	50*	–
6	58	54	30	63	24	22	43	52	6
7	44	44	41	47	22	10	35	20	–
8	47	41	65	47	43	–	41	80	20
9	44	44	33	56	40	20	44	40	–
10	50*	50*	50*	–	–	–	50*	–	–
11	67*	67*	67*	–	–	–	67*	–	–
12	33	67	83	40	–	–	67	75	–

*For these cases, the percentages were presented ‘as many as’ due to limited data.

HS, Health State.

Note: For description of health states, please see Table 1.

Figure 1.  Screenshot of the computerized time trade-off questionnaire: on the eQtool.

Figure 2.  Screen shot of the eQTool® depicting Health State 1.

Table 4.  Study demographics compared to Canadian national estimates.

Demographic characteristics	n	%	Census %^a	Adjusted census %^b	p-value^c
Age group
15–24 years old	287	35.0	16.2	15.8	<0.001^a,b
25–34 years old	169	20.6	15.4	17.5	0.005^a
35–44 years old	133	16.2	18.5	19.5	NS
45–54 years old	122	14.9	19.1	17.8	0.021^a
55–64 years old	63	7.7	14.1	12.7	<0.001^a,b
65–74 years old	36	4.4	8.8	8.5	<0.001^a,b
75 years old or above	9	1.1	7.9	8.2	<0.001^a,b
Missing	2	0.2
Gender
Male	306	37.3	48.5	47.7	<0.001^a,b
Female	515	62.7	51.5	52.3	<0.001^a,b
Education
No post-secondary degree, certificate of diploma	208	25.3	49.3	52.0	<0.001^a,b
Post-secondary degree, below baccalaureate	248	30.2	32.6	21.9	<0.001^b
Baccalaureate (Bachelor degree)	251	30.6	11.6	16.1	<0.001^a,b
University degree above baccalaureate	107	13.0	6.5	10.0	<0.001^a/0.043^b
Missing	7	0.9
Employment
Employed	545	66.4	62.4	61.2	0.009^a/0.002^b
Unemployed	81	9.9	4.4	4.7	<0.001^a
Not in labor force	168	20.5	33.2	34.1	<0.001^a,b
Missing	27	3.3
Income
$0–$19,999	297	36.2	43.9	42.7	NS
$20,000–$39,999	177	21.6	26.8	23.8	NS
$40,000–$59,999	131	16.0	15.1	15.7	NS
$60,000 and over	113	13.8	14.2	17.9	NS
Missing	103	12.5
Ethnicity
White	492	59.9	84.3	64.2	<0.001^a
Black	42	5.1	2.5	7.0	0.004^a
Hispanic or Latino	8	1.0	1.0	2.1	NS
Asian	261	31.8	12.2	26.6	<0.001^a/0.010^b

^aCanadian study population compared to Statistics Canada 2006 Canadian census for age, gender, education, employment, income, and ethnicity.

^bCanadian study population compared to Statistics Canada 2006 Canadian census for age, gender, education, employment, income, and ethnicity, adjusted for the urban areas including Hamilton, Toronto, and Ottawa.

^cStatistical contrast of sample characteristics and national proportions assessed with a χ² test for contingency tables.

Note: The proportions (%) are based on usable answers.

Figure 3.  Mean utility scores elicited from the time-trade-off and their corresponding 95%CI. HS, health state; CI, confidence interval. For description of health states, please see Table 1.

Table 5.  Utility scores elicited from the time trade-off analysis.

	Health state
	1	2	3	4	5	6	7	8	9	10	11	12
n*	265	266	263	263	267	268	269	259	273	264	266	267
Mean	0.633	0.623	0.620	0.592	0.628	0.588	0.605	0.579	0.545	0.549	0.517	0.476
Median	0.681	0.664	0.633	0.597	0.667	0.567	0.631	0.553	0.500	0.503	0.497	0.489
SD	0.282	0.274	0.269	0.272	0.276	0.276	0.267	0.275	0.279	0.280	0.289	0.271
95% CI	[0.599, 0.667]	[0.590, 0.656]	[0.586, 0.652]	[0.558, 0.624]	[0.595, 0.661]	[0.555, 0.621]	[0.573, 0.637]	[0.544, 0.612]	[0.512, 0.578]	[0.515, 0.582]	[0.481, 0.551]	[0.443, 0.508]
1st quartile	0.481	0.481	0.456	0.419	0.489	0.424	0.446	0.400	0.363	0.381	0.314	0.264
3rd quartile	0.891	0.846	0.833	0.822	0.850	0.814	0.833	0.803	0.767	0.767	0.767	0.679

*Number of participants with usable data.

CI, Confidence Interval; SD, Standard Deviation.

Note: For description of health states, please see Table 1.

Table 6.  Utility scores: Floor and ceiling effects.

Health state	Frequency (%)
	Number at floor (≤0.1)	Number at ceiling (≥0.9)
1	17 (6.4)	61 (23.0)
2	15 (5.6)	48 (18.0)
3	11 (4.2)	49 (18.6)
4	14 (5.3)	42 (16.0)
5	15 (5.6)	53 (19.9)
6	19 (7.1)	42 (15.7)
7	14 (5.2)	47 (17.5)
8	13 (5.0)	37 (14.3)
9	22 (8.1)	39 (14.3)
10	19 (7.2)	38 (14.4)
11	26 (9.8)	41 (15.4)
12	28 (10.5)	24 (9.0)

Note: For description of health states, please see Table 1.

Table 7.  Adjusted utility scores to match general population using direct standardization.

	Health state
	1	2	3	4	5	6	7	8	9	10	11	12
Base case	0.633	0.623	0.620	0.592	0.628	0.588	0.605	0.579	0.545	0.549	0.517	0.476
Standardized by age^a	0.619	0.612	0.630	0.619	0.613	0.558	0.602	0.556	0.541	0.525	0.519	0.450
Standardized by age^b	0.621	0.614	0.630	0.622	0.616	0.559	0.603	0.554	0.544	0.526	0.521	0.449
Standardized by gender^a	0.623	0.617	0.615	0.587	0.623	0.580	0.602	0.569	0.541	0.539	0.503	0.464
Standardized by gender^b	0.624	0.617	0.615	0.587	0.623	0.580	0.602	0.570	0.541	0.540	0.504	0.465
Standardized by level of education^a	0.611	0.611	0.598	0.560	0.611	0.579	0.583	0.562	0.531	0.534	0.522	0.464
Standardized by level of education^b	0.613	0.616	0.594	0.555	0.614	0.580	0.581	0.560	0.532	0.527	0.519	0.460
Standardized by employment status^a	0.623	0.631	0.610	0.593	0.618	0.581	0.594	0.570	0.546	0.537	0.510	0.471
Standardized by employment status^b	0.622	0.631	0.610	0.593	0.618	0.579	0.594	0.569	0.546	0.537	0.510	0.471
Standardized by income^a	0.629	0.611	0.612	0.590	0.622	0.585	0.601	0.586	0.554	0.544	0.507	0.473
Standardized by income^b	0.631	0.615	0.615	0.593	0.624	0.586	0.602	0.588	0.554	0.545	0.510	0.475
Standardized by ethnicity^a	0.632	0.622	0.631	0.596	0.635	0.608	0.617	0.595	0.558	0.547	0.520	0.480
Standardized by ethnicity^b	0.628	0.617	0.613	0.591	0.628	0.587	0.604	0.581	0.548	0.543	0.514	0.476

^aCanadian study population compared to Statistics Canada 2006 Canadian census for age, gender, education, employment, income, and ethnicity.

^bCanadian study population compared to Statistics Canada 2006 Canadian census for age, gender, education, employment, income, and ethnicity, adjusted for the urban areas including Hamilton, Toronto, and Ottawa.

Note: For description of health states, please see Table 1.

Table 8.  Sensitivity analysis: Outliers removed (values <0.05 and >0.95 are removed).

	Health State
	1	2	3	4	5	6	7	8	9	10	11	12
n	211	220	220	217	214	224	229	220	236	224	227	234
Mean	0.594	0.597	0.587	0.567	0.593	0.562	0.578	0.550	0.534	0.540	0.500	0.474
Median	0.636	0.633	0.596	0.533	0.631	0.500	0.556	0.500	0.499	0.500	0.486	0.489
SD	0.229	0.223	0.222	0.212	0.217	0.223	0.223	0.227	0.231	0.225	0.238	0.223
95% CI	[0.563, 0.625]	[0.567, 0.626]	[0.558, 0.617]	[0.538, 0.595]	[0.564, 0.622]	[0.533, 0.592]	[0.549, 0.607]	[0.520, 0.581]	[0.504, 0.564]	[0.510, 0.570]	[0.469, 0.531]	[0.445, 0.503]
Minimum	0.050	0.067	0.067	0.067	0.064	0.064	0.056	0.064	0.054	0.064	0.064	0.053
Maximum	0.950	0.946	0.950	0.950	0.933	0.947	0.946	0.950	0.947	0.950	0.947	0.947
1st quartile	0.475	0.480	0.449	0.426	0.486	0.429	0.441	0.401	0.397	0.397	0.329	0.286
3rd quartile	0.767	0.767	0.767	0.763	0.764	0.767	0.764	0.764	0.742	0.733	0.700	0.638
Missing	71	62	47	52	60	48	48	46	43	46	48	37

n, Number of participants with usable data with scores ≥0.05 or ≤0.95; CI, Confidence Interval; SD, Standard Deviation.

Note: For description of health states, please see Table 1.

Table A1.  Exact transcription of the text of the preamble and of the 12 health states as presented to the participants of the Time Trade-Off survey.

Component	Description
Preamble	• Imagine that you have a blood condition that causes your platelets to be abnormally low. Platelets are small cells found in your blood and their function is to prevent bleeding. When the number of platelets gets too low, there is a risk that you might suffer abnormal bleeding.
	• The bleeding that can occur varies from mild bruising to moderate internal bleeding to severe bleeding in the brain. These bleeding occurrences can be described as follows:
	• Bleeding under the skin (bruising or pinpoint red spots on the skin)	• Vaginal bleeding (a period) that is too heavy or that lasts too long
	• Mouth bleeding (bleeding gums, or blood blisters in the mouth)	• Internal bleeding (bleeding in the urine or stools)
	• Nose bleeds that last too long	• Bleeding in the brain
	• Bleeding from cuts that does not stop as quickly as it should
	• You may need treatment to increase the number of platelets in your blood. Potential treatments might include pills, or medications administered by injection into the veins, or by injections under the skin.
	• Sometimes, a treatment will work only for a short period of time or not at all. As a result, your platelet count will fall back down to low levels and you may need multiple treatments.
	• All treatments that you will receive have side effects. You might experience some of them. There is no way to know in advance if the treatment will work for you or if you will experience side effects.
	• The bleeding that might occur because of your blood condition and the side-effects from the treatments can affect your quality of life.
Health State 1	• We ask you now to imagine you have a blood condition that causes your platelet count to drop below normal levels. When the number of platelets gets too low, there is a risk that you might suffer abnormal bleeding.
	• Your doctor has prescribed you a medication that is an injection under the skin administered every week. You may administer the medication yourself, or receive a visit from a nurse at home.
	• The medication is successful in raising your platelet count back up to a normal level and you do not experience any bleeding that would require you to go see your doctor.
	• The medication that you receive is associated with side effects. In a group of 100 people taking the medication, 22 will experience joint pain, 14 will experience diarrhea and 11 will experience nausea.
	• People like you have reported that the condition or its treatment have had an impact on their quality of life. In a group of 100 people, a certain number reported the following effects some, most or all of the time:
	○ 52 people had difficulty falling asleep or would find themselves being awake during the night;
	○ 29 people felt physically unattractive due to bruising, scarring, wounds or the effect of their medication;
	○ 48 people felt worn out.
	• In the same group of 100 people, a certain number reported the following effects a good bit of the time, quite a bit of the time or extremely often:
	○ 26 people found that their condition limited their normal physical or sporting activities;
	○ 20 people felt that their condition negatively interfered with their ability to get a promotion at their job;
	○ 18 people were fearful of losing their job because of their condition.
	• In the same group of 100 people, 67 people felt that their physical health or emotional problems interfered with normal social activities quite a bit of the time or extremely often.
	• In a group of 100 women, 27 have heavier periods or vaginal bleeding during menstruation for more days or with more pain than before having this blood condition quite a bit of the time or extremely often.
	• Please take a moment to imagine what life would be like if you were in this health state for the rest of your life.
Health State 2	• We ask you now to imagine you have a blood condition that causes your platelet count to drop below normal levels. When the number of platelets gets too low, there is a risk that you might suffer abnormal bleeding.
	• Your doctor has prescribed you medications that are pills taken orally for up to 8 weeks at a time or an injection given by the vein in a hospital clinic over 1 or 2 days. The treatment may need to be repeated if your platelet count drops back below safe levels.
	• The medication is successful in raising your platelet count back up to a normal level and you do not experience any bleeding that would require you to go see your doctor.
	• The medication that you receive is associated with side effects. In a group of 100 people taking the medication, 8 will experience joint pain, 6 will experience diarrhea and 4 will experience nausea.
	• People like you reported that the condition or its treatment have had an impact on their quality of life. In a group of 100 people, a certain number reported the following effects some, most or all of the time:
	○ as many as 67 people found it difficult to fall asleep or would find themselves being awake during the night;
	○ as many as 67 people felt physically unattractive due to bruising, scarring, wounds or the effect of their medication;
	○ as many as 67 people felt worn out;
	• In the same group of 100 people, a certain number reported the following effects a good bit of the time, quite a bit of the time or extremely often:
	○ as many as 33 people found that their condition limited their normal physical or sporting activities;
	○ as many as 100 people have been fearful of losing their job because of their condition;
	• In the same group of 100 people, as many as 33 people felt that their physical health or emotional problems interfered with normal social activities quite a bit of the time or extremely often.
	• In a group of 100 women, as many as 100 women had heavier vaginal bleeding or bleeding for more days or more pain during menstrual periods than before having this blood condition quite a bit of the time or extremely often.
	• Please take a moment to imagine what life would be like if you were in this health state for the rest of your life.
Health State 3	• We ask you now to imagine you have a blood condition that causes your platelet count to drop below normal levels. When the number of platelets gets too low, there is a risk that you might suffer abnormal bleeding.
	• Your doctor has prescribed you a medication that is an injection under the skin administered every week. You may administer the medication yourself, or receive a visit from a nurse at home. The medication you receive may also be pills taken orally for up to 8 weeks at a time or an injection given by the vein in a hospital clinic over 1 or 2 days. The treatment may need to be repeated if your platelet count drops back below safe levels.
	• The medication is successful in raising your platelet count back up to a normal level but you experience bleeding that requires you to go see your doctor. The bleeding may be bruising or pinpoints red dots under the skin, blood blisters in the mouth or mild bleeding episodes such as nose bleeds, or gum bleeding.
	• The medication is not associated with side effects.
	• People like you reported that the condition or its treatment have had an impact on their quality of life. In a group of 100 people, a certain number reported the following effects some, most or all of the time:
	○ as many as 100 people found it difficult to fall asleep or would find themselves being awake during the night;
	○ as many as 50 people felt physically unattractive due to bruising, scarring, wounds or the effect of their medication;
	• In the same group of 100 people, a certain number reported the following effects a good bit of the time, quite a bit of the time or extremely often:
	○ as many as 33 people found that their condition limited their normal physical or sporting activities;
	○ as many as 50 people felt that their condition has negatively interfered with relationships with coworkers;
	○ as many as 75 people felt that their physical health or emotional problems interfered with normal social activities;
	• In a group of 100 women, as many as 50 women had heavier vaginal bleeding or bleeding for more days or more pain during menstrual periods than before having this blood condition quite a bit of the time or extremely often.
	• Please take a moment to imagine what life would be like if you were in this health state for the rest of your life.
Health State 4	• We ask you now to imagine you have a blood condition that causes your platelet count to drop below normal levels. When the number of platelets gets too low, there is a risk that you might suffer abnormal bleeding.
	• Your doctor has prescribed you a medication that is an injection under the skin administered every week. You may administer the medication yourself, or receive a visit from a nurse at home.
	• The medication is successful in raising your platelet count back up to a normal level but you experience bleeding that requires you to go see your doctor. The bleeding may be bruising or pinpoints red dots under the skin, blood blisters in the mouth or mild bleeding episodes such as nose bleeds, or gum bleeding.
	• The medication that you receive is associated with side effects. In a group of 100 people taking the medication, 22 will experience joint pain, 14 will experience diarrhea and 11 will experience nausea.
	• People like you reported that the condition or its treatment have had an impact on their quality of life. In a group of 100 people, a certain number reported the following effects some, most or all of the time:
	○ 67 people found it difficult to fall asleep or would find themselves being awake during the night;
	○ 83 people felt physically unattractive due to bruising, scarring, wounds or the effect of their medication;
	○ 33 people felt worn out;
	• In the same group of 100 people, a certain number reported the following effects a good bit of the time, quite a bit of the time or extremely often:
	○ 29 people found that their condition limited their normal physical or sporting activities;
	○ 100 people felt that their condition negatively interfered with their ability to get a promotion at their job;
	○ 100 people felt that their condition has negatively interfered with relationships with coworkers;
	○ 100 people have been fearful of losing their job because of their condition;
	• In the same group of 100 people, 29 people felt that their physical health or emotional problems interfered with normal social activities quite a bit of the time or extremely often.
	• Please take a moment to imagine what life would be like if you were in this health state for the rest of your life.
Health State 5	• We ask you now to imagine that you have a blood condition that causes your platelet count to drop below normal levels. When the number of platelets gets too low, there is a risk that you might suffer abnormal bleeding.
	• Your doctor has prescribed you medications that are pills taken orally for up to 8 weeks at a time or an injection given by the vein in a hospital clinic over 1 or 2 days. The treatment may need to be repeated if your platelet count drops back below safe levels.
	• The medication is successful in raising your platelet count back up to a normal level but you experience bleeding that requires you to go see your doctor. The bleeding may be bruising or pinpoints red dots under the skin, blood blisters in the mouth or mild bleeding episodes such as nose bleeds, or gum bleeding.
	• The medication that you receive is associated with side effects. In a group of 100 people taking the medication, 8 will experience joint pain, 6 will experience diarrhea and 4 will experience nausea.
	• People like you reported that the condition or its treatment have had an impact on their quality of life. In a group of 100 people, a certain number reported the following effects some, most or all of the time:
	○ as many as 67 people found it difficult to fall asleep or would find themselves being awake during the night;
	○ as many as 83 people felt physically unattractive due to bruising, scarring, wounds or the effect of their medication;
	○ as many as 67 people felt worn out.
	• In the same group of 100 people, a certain number reported the following effects a good bit of the time, quite a bit of the time or extremely often:
	○ as many as 50 people found that their condition limited their normal physical or sporting activities;
	○ as many as 50 people have been fearful of losing their job because of their condition.
	• In a group of 100 women, as many as 50 women had heavier vaginal bleeding or bleeding for more days or more pain during menstrual periods than before having this blood condition quite a bit of the time or extremely often.
	• Please take a moment to imagine what life would be like if you were in this health state for the rest of your life.
Health State 6	• We ask you now to imagine that you have a blood condition that causes your platelet count to drop below normal levels. When the number of platelets gets too low, there is a risk that you might suffer abnormal bleeding.
	• Your doctor has prescribed you a medication that is an injection under the skin administered every week. You may administer the medication yourself, or receive a visit from a nurse at home. The medication you receive may also be pills taken orally for up to 8 weeks at a time or an injection given by the vein in a hospital clinic over 1 or 2 days. The treatment may need to be repeated if your platelet count drops back below safe levels.
	• The medication is not successful in raising your platelet count back up to a normal level but you do not experience any bleeding that would require you to go see your doctor.
	• The medication is not associated with side effects.
	• People like you reported that the condition or its treatment have had an impact on their quality of life. In a group of 100 people, a certain number reported the following effects some, most or all of the time:
	○ 58 people found it difficult to fall asleep or would find themselves being awake during the night;
	○ 30 people felt physically unattractive due to bruising, scarring, wounds or the effect of their medication;
	○ 54 people felt worn out;
	• In the same group of 100 people, a certain number reported the following effects a good bit of the time, quite a bit of the time or extremely often:
	○ 43 people found that their condition limited their normal physical or sporting activities;
	○ 24 people felt that their condition negatively interfered with their ability to get a promotion at their job;
	○ 6 people felt that their condition has negatively interfered with relationships with coworkers;
	○ 22 people have been fearful of losing their job because of their condition;
	• In the same group of 100 people, 63 people felt that their physical health or emotional problems interfered with normal social activities quite a bit of the time or extremely often;
	• In a group of 100 women, 52 women had heavier vaginal bleeding or bleeding for more days or more pain during menstrual periods than before having this blood condition quite a bit of the time or extremely often.
	• Please take a moment to imagine what life would be like if you were in this health state for the rest of your life.
Health State 7	• We ask you now to imagine that you have a blood condition that causes your platelet count to drop below normal levels. When the number of platelets gets too low, there is a risk that you might suffer abnormal bleeding.
	• Your doctor has prescribed you a medication that is an injection under the skin administered every week. You may administer the medication yourself, or receive a visit from a nurse at home.
	• The medication is not successful in raising your platelet count back up to a normal level but you do not experience any bleeding that would require you to go see your doctor.
	• The medication that you receive is associated with side effects. In a group of 100 people taking the medication, 22 will experience joint pain, 14 will experience diarrhea and 11 will experience nausea.
	• People like you reported that the condition or its treatment have had an impact on their quality of life. In a group of 100 people, a certain number reported the following effects some, most or all of the time:
	○ 44 people found it difficult to fall asleep or would find themselves being awake during the night;
	○ 41 people felt physically unattractive due to bruising, scarring, wounds or the effect of their medication;
	○ 44 people felt worn out;
	• In the same group of 100 people, a certain number reported the following effects a good bit of the time, quite a bit of the time or extremely often:
	○ 35 people found that their condition limited their normal physical or sporting activities;
	○ 22 people felt that their condition negatively interfered with their ability to get a promotion at their job;
	○ 10 people have been fearful of losing their job because of their condition;
	• In the same group of 100 people, 47 people felt that their physical health or emotional problems interfered with normal social activities quite a bit of the time or extremely often;
	• In a group of 100 women, 20 women had heavier vaginal bleeding or bleeding for more days or more pain during menstrual periods than before having this blood condition quite a bit of the time or extremely often.
	• Please take a moment to imagine what life would be like if you were in this health state for the rest of your life.
Health State 8	• We ask you now to imagine that you have a blood condition that causes your platelet count to drop below normal levels. When the number of platelets gets too low, there is a risk that you might suffer abnormal bleeding.
	• Your doctor has prescribed you medications that are pills taken orally for up to 8 weeks at a time or an injection given by the vein in a hospital clinic over 1 or 2 days. The treatment may need to be repeated if your platelet count drops back below safe levels.
	• The medication is not successful in raising your platelet count back up to a normal level but you do not experience any bleeding that would require you to go see your doctor.
	• The medication that you receive is associated with side effects. In a group of 100 people taking the medication, 8 will experience joint pain, 6 will experience diarrhea and 4 will experience nausea.
	• People like you reported that the condition or its treatment have had an impact on their quality of life. In a group of 100 people, a certain number reported the following effects some, most or all of the time:
	○ 47 people found it difficult to fall asleep or would find themselves being awake during the night;
	○ 65 people felt physically unattractive due to bruising, scarring, wounds or the effect of their medication;
	○ 41 people felt worn out;
	• In the same group of 100 people, a certain number reported the following effects a good bit of the time, quite a bit of the time or extremely often:
	○ 41 people found that their condition limited their normal physical or sporting activities;
	○ 43 people felt that their condition negatively interfered with their ability to get a promotion at their job;
	○ 20 people felt that their condition has negatively interfered with relationships with coworkers.
	• In the same group of 100 people, 47 people felt that their physical health or emotional problems interfered with normal social activities quite a bit of the time or extremely often;
	• In a group of 100 women, 80 women had heavier vaginal bleeding or bleeding for more days or more pain during menstrual periods than before having this blood condition quite a bit of the time or extremely often.
	• Please take a moment to imagine what life would be like if you were in this health state for the rest of your life.
Health State 9	• We ask you now to imagine that you have a blood condition that causes your platelet count to drop below normal levels. When the number of platelets gets too low, there is a risk that you might suffer abnormal bleeding.
	• Your doctor has prescribed you a medication that is an injection under the skin administered every week. You may administer the medication yourself, or receive a visit from a nurse at home. The medication you receive may also be pills taken orally for up to 8 weeks at a time or an injection given by the vein in a hospital clinic over 1 or 2 days. The treatment may need to be repeated if your platelet count drops back below safe levels.
	• The medication is not successful in raising your platelet count back up to a normal level and you experience bleeding that requires you to go see your doctor. The bleeding may be bruising or pinpoints red dots under the skin, blood blisters in the mouth or mild bleeding episodes such as nose bleeds, or gum bleeding.
	• The medication is not associated with side effects.
	• People like you reported that the condition or its treatment have had an impact on their quality of life. In a group of 100 people, a certain number reported the following effects some, most or all of the time:
	○ 44 people found it difficult to fall asleep or would find themselves being awake during the night;
	○ 33 people felt physically unattractive due to bruising, scarring, wounds or the effect of their medication;
	○ 44 people felt worn out;
	○ In the same group of 100 people, a certain number reported the following effects a good bit of the time, quite a bit of the time or extremely often:
	○ 44 people found that their condition limited their normal physical or sporting activities;
	○ 40 people felt that their condition negatively interfered with their ability to get a promotion at their job;
	○ 20 people have been fearful of losing their job because of their condition.
	○ In the same group of 100 people, 56 people felt that their physical health or emotional problems interfered with normal social activities quite a bit of the time or extremely often;
	• In a group of 100 women, 40 women had heavier vaginal bleeding or bleeding for more days or more pain during menstrual periods than before having this blood condition quite a bit of the time or extremely often.
	• Please take a moment to imagine what life would be like if you were in this health state for the rest of your life.
Health State 10	• We ask you now to imagine that you have a blood condition that causes your platelet count to drop below normal levels. When the number of platelets gets too low, there is a risk that you might suffer abnormal bleeding.
	• Your doctor has prescribed you a medication that is an injection under the skin administered every week. You may administer the medication yourself, or receive a visit from a nurse at home.
	• The medication is not successful in raising your platelet count back up to a normal level and you experience bleeding that requires you to go see your doctor. The bleeding may be bruising or pinpoints red dots under the skin, blood blisters in the mouth or mild bleeding episodes such as nose bleeds, or gum bleeding.
	• The medication that you receive is associated with side effects. In a group of 100 people taking the medication, 22 will experience joint pain, 14 will experience diarrhea and 11 will experience nausea.
	• People like you reported that the condition or its treatment have had an impact on their quality of life. In a group of 100 people, a certain number reported the following effects some, most or all of the time:
	○ as many as 50 people found it difficult to fall asleep or would find themselves being awake during the night;
	○ as many as 50 people felt physically unattractive due to bruising, scarring, wounds or the effect of their medication;
	○ as many as 50 people felt worn out;
	• In the same group of 100 people, as many as 50 people found that their condition limited their normal physical or sporting activities a good bit of the time, quite a bit of the time or extremely often.
	• Please take a moment to imagine what life would be like if you were in this health state for the rest of your life.
Health State 11	• We ask you now to imagine that you have a blood condition that causes your platelet count to drop below normal levels. When the number of platelets gets too low, there is a risk that you might suffer abnormal bleeding.
	• Your doctor has prescribed you medications that are pills taken orally for up to 8 weeks at a time or an injection given by the vein in a hospital clinic over 1 or 2 days. The treatment may need to be repeated if your platelet count drops back below safe levels.
	• The medication is not successful in raising your platelet count back up to a normal level and you experience bleeding that requires you to go see your doctor. The bleeding may be bruising or pinpoints red dots under the skin, blood blisters in the mouth or mild bleeding episodes such as nose bleeds, or gum bleeding.
	• The medication that you receive is associated with side effects. In a group of 100 people taking the medication, 8 will experience joint pain, 6 will experience diarrhea and 4 will experience nausea.
	• People like you reported that the condition or its treatment have had an impact on their quality of life. In a group of 100 people, a certain number reported the following effects some, most or all of the time:
	○ as many as 67 people found it difficult to fall asleep or would find themselves being awake during the night;
	○ as many as 100 people felt physically unattractive due to bruising, scarring, wounds or the effect of their medication;
	○ as many as 67 people felt worn out;
	• In the same group of 100 people, as many as 67 people found that their condition limited their normal physical or sporting activities a good bit of the time, quite a bit of the time or extremely often.
	• Please take a moment to imagine what life would be like if you were in this health state for the rest of your life.
Health State 12	• We ask you now to imagine that you have a blood condition that causes your platelet count to drop below normal levels. When the number of platelets gets too low, there is a risk that you might suffer abnormal bleeding.
	• Your doctor has prescribed you a medication that is an injection under the skin administered every week. You may administer the medication yourself, or receive a visit from a nurse at home. The medication you receive may also be pills taken orally for up to 8 weeks at a time or an injection given by the vein in a hospital clinic over 1 or 2 days. The treatment may need to be repeated if your platelet count drops back below safe levels.
	• The medication is not successful in raising your platelet count back up to a normal level and you experience bleeding requiring that you go to see your doctor. The bleeding may be external (nose bleeds or bleeding from cuts that lasts too long, vaginal bleeding that is too heavy or that lasts too long) or internal (bleeding in the urine or stools, bleeding in the brain). If you experience internal bleeding, you may need to be hospitalized 5 to 15 days.
	• People like you reported that the condition or its treatment have had an impact on their quality of life. In a group of 100 people, a certain number reported the following effects some, most or all of the time:
	○ 33 people found it difficult to fall asleep or would find themselves being awake during the night;
	○ 83 people felt physically unattractive due to bruising, scarring, wounds or the effect of their medication;
	○ 67 people felt worn out;
	• In the same group of 100 people, 67 people found that their condition limited their normal physical or sporting activities a good bit of the time, quite a bit of the time or extremely often; 40 people felt that their physical health or emotional problems interfered with normal social activities quite a bit of the time or extremely often;
	• In a group of 100 women, 75 women had heavier vaginal bleeding or bleeding for more days or more pain during menstrual periods than before having this blood condition quite a bit of the time or extremely often.
	• Please take a moment to imagine what life would be like if you were in this health state for the rest of your life.