Process Utility in Breast Biopsy

Purpose . To determine whether the waiting trade-off (WTO) is feasible for differentiating short-term biopsy preferences in an acute situation where anxiety is the symptomatic disease state. Methods . 75 women with past experience of either breast core-needle biopsy (CNB), more invasive excisional surgical biopsy (EXB), or both, had telephone WTO assessments. Patients' baseline and test-related anxiety were valued by time trade-off (TTO) used to scale the WTO. Rating scales (RS) were obtained for convergent validity assessment with WTO and TTO. Results . Data were obtained in 38 women who had both CNB and EXB (“paired”) and 20 who had CNB only and 16 who had EXB only (“unpaired”). Patients rated only the procedure(s) they experienced. Median paired and mean unpaired WTO scores indicated patients were willing to wait significantly longer to avoid EXB (P = 0.0003, P = 0.0002, respectively). The waiting time difference between EXB and CNB was 2.1 weeks greater in unpaired data than paired data. RS scores comparing the procedures were significantly different only for paired data (P < 0.05). Median TTO preferences for baseline (1.00) and test anxiety (0.93) obtained in 74 patients were significantly different (P < 0.0001) and consistent with RS. Correlation was noted between WTO and RS (-0.307 to -0.453, P = 0.0205 to 0.0001). The median EXB quality-adjusted life years toll (1.5 quality-adjusted life days) calculated from pooled WTO data (paired and unpaired) from 54 patients is near a threshold in a published model. Conclusion . The WTO is feasible for discriminating preferences for short-term health states in an acute medical scenario where it might have been expected to be impracticable.

[1]  P. Shackley,et al.  Does "process utility" exist? A case study of willingness to pay for laparoscopic cholecystectomy. , 1997, Social science & medicine.

[2]  D. Feeny,et al.  Do They Have a Role in the Measurement of Preferences for Health States , 2001 .

[3]  J. Bosch,et al.  Time-tradeoff Values and Standard-gamble Utilities Assessed during Telephone Interviews versus Face-to-face Interviews , 1998, Medical decision making : an international journal of the Society for Medical Decision Making.

[4]  J S Swan,et al.  A Time-tradeoff Method for Cost—Efifectiveness Models Applied to Radiology , 2000, Medical decision making : an international journal of the Society for Medical Decision Making.

[5]  L. Bassett,et al.  Imaging‐Guided Core Needle Biopsy of the Breast: Study of Psychological Outcomes , 2000, The breast journal.

[6]  Jennifer S. Haas,et al.  Differences in the quality of care for women with an abnormal mammogram or breast complaint , 2000, Journal of general internal medicine.

[7]  M. Weinstein,et al.  Identifying and Valuing Outcomes , 1996 .

[8]  M. Boyle,et al.  Multiattribute and Single‐Attribute Utility Functions for the Health Utilities Index Mark 3 System , 2002, Medical care.

[9]  J. Richardson,et al.  A cost utility analysis of treatment options for gallstone disease: methodological issues and results. , 1994, Health economics.

[10]  E. A. Nelson,et al.  Systematic reviews of wound care management: (2). Dressings and topical agents used in the healing of chronic wounds. , 1999, Health technology assessment.

[11]  C. Langlotz,et al.  Cost-effectiveness of MR imaging and core-needle biopsy in the preoperative work-up of suspicious breast lesions. , 1999, Radiology.

[12]  G. Torrance.  Measurement of health state utilities for economic appraisal. , 1986, Journal of health economics.

[13]  M Johannesson,et al.  An Experimental Test of a Theoretical Foundation for Rating-scale Valuations , 1997, Medical decision making : an international journal of the Society for Medical Decision Making.

[14]  L. Rybicki,et al.  A prospective review of the decline of excisional breast biopsy. , 2002, American journal of surgery.

[15]  C. Langlotz,et al.  Cost-effectiveness of MR angiography in cases of limb-threatening peripheral vascular disease. , 1995, Radiology.

[16]  D. Matchar,et al.  Depression and Other Determinants of Values Placed on Current Health State by Stroke Patients: Evidence From the VA Acute Stroke (VASt) Study , 2000, Stroke.

[17]  D. Heisey,et al.  Process utility for imaging in cerebrovascular disease. , 2003, Academic radiology.

[18]  W. Lawrence,et al.  Short-term impact of cancer prevention and screening activities on quality of life. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[19]  S. Jansen,et al.  Patients' Utilities for Cancer Treatments , 1998, Medical decision making : an international journal of the Society for Medical Decision Making.

[20]  R M Kaplan,et al.  A general health policy model: update and applications. , 1988, Health services research.

[21]  P. Duncan,et al.  Utilities for major stroke: results from a survey of preferences among persons at increased risk for stroke. , 1998, American heart journal.