title: Worst-case future scenarios of patients with rheumatoid arthritis: a cross-sectional study.
abstract: OBJECTIVE
  The time trade-off is a health-related quality of life instrument that measures valuations for health states (utilities) by asking patients to value their health state anchored on a scale between death (0) and perfect health (1). Dying earlier is not perceived as a realistic worst-case consequence of the disease by RA patients. Of the previous focus groups study on RA patients, five worst-case future scenarios emerged. The aim of this study was to examine which potential worst-case scenario was the most appropriate for RA patients to use in utility calculation.
  
  
  METHODS
  In a cross-sectional study of 74 consecutive RA patients visiting the rheumatology outpatient clinic, participants were presented with descriptions of the five worst-case future scenarios. In pairwise comparisons, patients had to choose the scenario that would be the worst to experience. The worst-case future scenario was defined by the scenario that was chosen by a significantly greater proportion of participants than could be expected based on chance (20%). Therefore, analysis based on a single fraction ( ) was used and 95% CI was calculated.
  
  
  RESULTS
  The scenario being dependent on others was chosen most often as the worst to experience [by 35% of participants (95% CI 24%, 46%)] and significantly more often than could be expected based on chance (  = 0.35, z = 6.45, P = 0.00).
  
  
  CONCLUSIONS
  The scenario being dependent on others is likely to be the most appropriate worst-case future scenario for RA patients. Using an alternative anchor could improve the validity and responsiveness of the time trade-off in RA patients.
authors: Faculty of Behavioural Sciences, Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands. l.buitinga@gw.utwente.nl
authors: Laurien
authors: L
authors: Buitinga
authors: Louise M A
authors: LM
authors: Braakman-Jansen
authors: Erik
authors: E
authors: Taal
authors: Mart A F J
authors: MA
authors: van de Laar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D003430:Cross-Sectional Studies; D003858:Dependency, Psychological; D006233:Persons with Disabilities / Q000523:psychology; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D057240:Patient Preference; D010865:Pilot Projects; D011788:Quality of Life; D012944:Social Support; D055815:Young Adult