Effects of decision aids for menorrhagia on treatment choices, health outcomes, and costs: a randomized controlled trial.
BACKGROUND
Decision aids can increase patient involvement in treatment decision making. However, questions remain regarding their effects and cost implications.


OBJECTIVE
To evaluate the effects of information, with and without a structured preference elicitation interview, on treatment choices, health outcomes, and costs.


METHODS
A randomized controlled trial with 2 years of follow-up. Between October 1996 and February 1998, 894 women with uncomplicated menorrhagia were recruited from 6 hospitals in southwest England. Women were randomized to the control group, information alone group (information), or information plus interview group (interview).


METHODS
Women in both intervention groups were sent an information pack (a booklet and complementary videotape) 6 weeks before their specialist consultation. Immediately before their consultation, women in the interview group underwent structured interview, to clarify and elicit their preferences.


METHODS
Self-reported health status was the main outcome; secondary outcomes included treatments received and costs. Cost analyses adopted a UK health service (payer) perspective, and were based on patient-reported resource use data and are reported in 1999-2000 US dollars.


RESULTS
The interventions had no consistent effect on health status. Hysterectomy rates were lower for women in the interview group (38%) (adjusted odds ratio [OR], 0.60; 95% confidence interval [CI], 0.38-0.96) than in the control group (48%) and women who received the information alone (48%) (adjusted OR, 0.52; 95% CI, 0.33-0.82). The interview group had lower mean costs ($1566) than the control group ($2751) (mean difference, $1184; 95% CI, $684-$2110) and the information group $2026 (mean difference, $461; 95% CI, $236-$696).


CONCLUSIONS
Neither intervention had an effect on health status. Providing women with information alone did not affect treatment choices; however, the addition of an interview to clarify values and elicit preferences had a significant effect on women's management and resulted in reduced costs.
Kennedy
Andrew D M
AD
Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UB8 3PH England. andrew.kennedy@brunel.ac.uk
Sculpher
Mark J
MJ
Coulter
Angela
A
Dwyer
Nuala
N
Rees
Margaret
M
Abrams
Keith R
KR
Horsley
Susan
S
Cowley
Deborah
D
Kidson
Christine
C
Kirwin
Catherine
C
Naish
Caroline
C
Stirrat
Gordon
G
D000328:Adult; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000706:statistics & numerical data; D008595:Menorrhagia / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic; D010358:Patient Participation; D006113:United Kingdom