The impact of risk on preference values: implications for evaluations of postmenopausal osteoporosis therapy.
OBJECTIVE
The objective was to assess the impact of different levels of risk of disease on a woman's preferences for health states. Women were provided with health scenarios incorporating different levels of lifetime risks for breast cancer, hip fracture, and coronary heart disease (CHD). In this way, we were able to determine the incremental effect of changes in risks of each disease on preference values.


METHODS
Preference values and utility scores were obtained for six health scenarios by both the feeling thermometer (FT) and standard gamble (SG) methods. Scenarios presented the different lifetime risks of CHD, breast cancer, and hip fracture associated with and not associated with long-term use of hormone replacement therapy (HRT) and raloxifene. Risks of breast cancer were based on perceived risks and population risks. The sample population consisted of 40 healthy female volunteers aged between 45 and 65 years randomly selected from the Ottawa-Carleton district.


RESULTS
Based on their perceived risk of breast cancer, the women had higher value scores for the raloxifene risk profile than for both HRT (p = .002) and no therapy (p = .003), with similar results for analyses based on population risks and from utility scores. Regression analysis showed that the risk of breast cancer (p < .001) was the only disease risk that was statistically significantly associated with women's preferences.


CONCLUSIONS
Women had significant preferences over the different risk profiles, primarily due to the incremental effect on changes in values for the risk of breast cancer. Therefore, studies evaluating therapies for osteoporosis should consider patient preferences for living with different risk profiles.
Coyle
D
D
Departments of Medicine and Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada. dcoyle@lri.ca
Wells
G
G
Graham
I
I
Lee
K M
KM
Peterson
J E
JE
Papadimitropoulos
E
E
D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000523:psychology; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000453:epidemiology* / Q000523:psychology; D003657:Decision Making; D015914:Estrogen Replacement Therapy / Q000706:statistics & numerical data; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D009864:Ontario; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D010465:Perception; D011336:Probability; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D012044:Regression Analysis; D018570:Risk Assessment; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D026712:Value of Life / Q000191:economics; D016387:Women's Health
D020845:Selective Estrogen Receptor Modulators; D020849:Raloxifene Hydrochloride