Choice-matching preference reversals in health outcome assessments.
BACKGROUND
Health outcome utility assessments generally assume procedural invariance. Preference reversals violating procedural invariance occur in economic scenarios when the assessment process shifts from a choice to a fill-in-the-blank task.


OBJECTIVE
To determine if similar reversals occur in utility assessments.


METHODS
One hundred thirty-six volunteer subjects completed 6 preference assessments of 4 personal health scenarios. Patients responded to otherwise identical tasks using either choice or fill-in-the-blank processes in a randomized crossover design. The authors determined the percentage of subjects preferring, or inferred to prefer, a given choice.


RESULTS
Preference reversals occurred in all assessment scenarios.


CONCLUSIONS
These preference reversals are a potential source of confusion for utility assessment and informed consent. They could be manipulated to achieve ends other than the best interest of patients. Anchoring or the prominence hypothesis may explain these findings.
Sumner
W
W
Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri 63110-1093, USA. wsumner@im.wustl.edu
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D000328:Adult; D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D005260:Female; D015276:Health Care Rationing; D006302:Health Services Research / Q000379:methods*; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders; D008923:Missouri; D011594:Psychometrics / Q000379:methods*; D011795:Surveys and Questionnaires; D026712:Value of Life