title: A randomized study of scleroderma health state values: a picture is worth a thousand words, and quite a few utiles. [corrected].
abstract: OBJECTIVE
  Assigning utilities to hypothetical health states requires that the health states be described in adequate detail, but there is no agreement on exactly how health states should be described. We assess utilities from the general public for health states common in scleroderma (SSc) by describing the health states in writing alone v. with photographs of patients with SSc.
  
  
  METHODS
  Subjects rated several SSc health states on a 0 to 100 rating scale (RS) and completed computer-assisted time tradeoff (TTO; range, 0.0-1.0) and standard gamble (SG; range, 0.0-1.0) assessments. Half of the subjects were assigned to be shown photographs of patients with SSc health states in addition to written health state descriptions, whereas the other half were given only the written descriptions.
  
  
  RESULTS
  Of the 213 participants, 133 (62%) were female, 138 (65%) were Caucasian, and 62 (29%) were African American. Median RS, TTO, and SG scores for 5 SSc health states ranged from 20 to 70, 0.28 to 0.94, and 0.50 to 0.90, respectively. In bivariate analyses, showing pictures was associated with lower RS scores for 2 of 5 health states and lower SG values for all 5 health states (P < 0:05 for comparison of pictures v. no pictures), but with no difference in TTO values. Multivariable analyses revealed negative associations between pictures and SG valuations for the 3 most severe SSc health states (R(2) range, 0.04-0.08).
  
  
  CONCLUSIONS
  Adding pictures of people with SSc to written health state descriptions can affect valuations of SSc health states, although the effect differs by valuation measurement method and by health state severity.
authors.affiliation: Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA. dkhanna@mednet.ucla.edu
authors.forename: Dinesh
authors.initials: D
authors.lastname: Khanna
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kaplan
authors.forename: Mark H
authors.initials: MH
authors.lastname: Eckman
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Leonard
authors.forename: Shaari S
authors.initials: SS
authors.lastname: Ginsburg
authors.forename: Joel
authors.initials: J
authors.lastname: Tsevat
mesh_terms: D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D010781:Photography; D012594:Scleroderma, Localized; D012720:Severity of Illness Index; D018434:Sickness Impact Profile