title: A randomized multicenter trial to evaluate simple utility elicitation techniques in patients with gastroesophageal reflux disease.
abstract: BACKGROUND
  Despite recommendations that patients rating their own health using utility and preference measures such as the feeling thermometer (FT) and standard gamble (SG) should also rate hypothetical marker states, little evidence supports marker state use. We evaluated whether the administration of marker states improves measurement properties of the FT and SG.
  
  
  METHODS
  We randomized 217 patients with gastroesophageal reflux disease to complete the FT (self-administered) and SG with marker states (FT+ / SG+, n = 112) or without marker states (FT- / SG-, n = 105) before and after 4 weeks of treatment with a proton pump inhibitor, esomeprazole. Patients also completed other health-related quality of life instruments.
  
  
  RESULTS
  The use of marker states did not influence baseline utility scores (FT+ 0.66, FT- 0.68; SG+ 0.77, SG- 0.78, on a scale from 0 [dead] to 1.0 [full health]). Improvement after therapy was 0.21 in FT+ and 0.15 in FT- (both P < 0.001; difference between FT+ and FT- = 0.06, P = 0.02). Improvement in SG+ was 0.07 (P < 0.001) and 0.06 in SG- (P = 0.003) (difference between SG+ and SG- = 0.01, P = 0.63). Correlations with other health-related quality of life scores were generally stronger, with some statistically significant differences in correlations, for FT+ compared with FT-, but tended to be weaker for SG+ compared with SG-.
  
  
  CONCLUSIONS
  The administration of marker states improved the responsiveness and validity of the FT but not of the SG. Decisions about administering marker states should depend on whether the FT and SG is of primary interest and the importance of optimal validity and responsiveness relative to competing objectives such as efficiency.
authors.affiliation: Department of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA. schuneh@mcmaster.ca
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
authors.forename: Alessio
authors.initials: A
authors.lastname: Degl'innocenti
authors.forename: Ingela
authors.initials: I
authors.lastname: Wiklund
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Fallone
authors.forename: Lisa
authors.initials: L
authors.lastname: Tanser
authors.forename: Sander Veldhuyzen
authors.initials: SV
authors.lastname: Van Zanten
authors.forename: Diane
authors.initials: D
authors.lastname: Heels-Ansdell
authors.forename: Samer
authors.initials: S
authors.lastname: El-Dika
authors.forename: Naoki
authors.initials: N
authors.lastname: Chiba
authors.forename: Alan N
authors.initials: AN
authors.lastname: Barkun
authors.forename: Peggy
authors.initials: P
authors.lastname: Austin
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D018434:Sickness Impact Profile