Associations between health status and utilities implications for policy.
BACKGROUND
If shape of a person's utility function is associated with his health status, as is predicted by Prospect Theory, the use of utilities from the healthy could result in 'de facto' discrimination against the sick.


OBJECTIVE
To determine if patients' utilities for hypothetical states and for their current health were associated with their health status.


METHODS
A cross-sectional study of the health and values of patients with depressive illnesses.


METHODS
Patients from three large primary care practices with various medical illnesses complicated by symptoms of depression.


METHODS
Short-Form 12 health status measurements, standard gamble, and visual analog scale preference measurements for patients' current health and for three hypothetical states.


RESULTS
One hundred and forty nine patients enrolled in the study and 139 patients completed the survey. Utilities for the best and worst states were similar across different levels of health status; however, standard gamble utilities for intermediate health states were higher for patients in poorer health than patients in better health (P = 0.019,) suggesting utility functions with radically different shapes. Utilities for patients' current health were also associated with their health status. Patients in poor health tended to overvalue their current health relative to the most similar hypothetical state; whereas, patients in good health tended undervalue their current health state (P = 0.036).


CONCLUSIONS
In patients with depressive illnesses, there were significant interactions between health and values, that were consistent with the predictions of Prospect Theory, and that could result in systematic under valuation of the health effects of treatments that primarily benefit more severely patients ill.
Lenert
L A
LA
Section on Health Services Research, Department of Veterans Affairs Health Care System, San Diego, CA 92161, USA. llenert@ucsd.edu
Treadwell
J R
JR
Schwartz
C E
CE
D000328:Adult; D000704:Analysis of Variance; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D005260:Female; D006291:Health Policy; D006305:Health Status Indicators; D006801:Humans; D015141:Los Angeles; D008297:Male; D008396:Maryland; D008875:Middle Aged; D018579:Patient Selection; D011795:Surveys and Questionnaires