Whose preferences should be elicited for use in health-care decision-making? A case study using anticoagulant therapy

Abstract

The question of whose preferences to elicit in health-state valuation has been widely discussed in the literature. The importance of this debate lies in the fact that health-state utility values are used in health technology assessment (HTA); therefore, an individual’s preferences can influence decision-making. If preferences differ across groups, making decisions based on one group’s preferences may be suboptimal for the other. Preferences for benefits, risks, experiences and health states associated with anticoagulant therapies have been elicited by researchers due to the underutilization of warfarin and the introduction of non-vitamin K antagonist oral anticoagulants. The majority of existing studies elicit preferences from patient populations as opposed to other stakeholders such as the general public. This paper extends the preference debate by using this clinical area as a case study, with a particular focus on HTA guidelines and the recent advocacy of the use of preference information in benefit–risk assessments.

KEYWORDS:

• Anticoagulant therapy
• benefit–risk assessment
• cost–effectiveness analysis
• preference elicitation
• utility assessment

Key issues

• The question of whose preferences to elicit in health-state valuation has been widely discussed in the literature, and it could be argued that this debate is relevant when preference information is elicited for other purposes.

• Preferences for benefits, risks, experiences and health states associated with anticoagulant therapies have been elicited using several different methodologies and it is patient preferences that are typically elicited.

• This preference information could be used to aid health technology assessments or benefit–risk assessments. If this is the case, it is important to consider whose preferences should be elicited. Guidelines regarding whose preferences to elicit for the former exist in a number of countries, whereas clear guidance on this issue does not exist for the latter.

• While patient preferences are undeniably relevant, and increasingly considered to be important by policymakers, it could be argued that preferences elicited from alternate populations are important when preference information is used to influence decision-making.

Acknowledgements

The authors would like to thank Professor Luke Vale and Dr Laura Ternent for their advice and comments on an earlier draft of this paper. We would also like to thank four anonymous referees for their constructive comments.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.