title: Individualized cost-effectiveness analysis of patient-centered care: a case series of hospitalized patient preferences departing from practice-based guidelines.
abstract: OBJECTIVE
  To develop cases of preference-sensitive care and analyze the individualized cost-effectiveness of respecting patient preference compared to guidelines.
  
  
  METHODS
  Four cases were analyzed comparing patient preference to guidelines: (a) high-risk cancer patient preferring to forgo colonoscopy; (b) decubitus patient preferring to forgo air-fluidized bed use; (c) anemic patient preferring to forgo transfusion; (d) end-of-life patient requesting all resuscitative measures. Decision trees were modeled to analyze cost-effectiveness of alternative treatments that respect preference compared to guidelines in USD per quality-adjusted life year (QALY) at a $100,000/QALY willingness-to-pay threshold from patient, provider and societal perspectives.
  
  
  RESULTS
  Forgoing colonoscopy dominates colonoscopy from patient, provider, and societal perspectives. Forgoing transfusion and air-fluidized bed are cost-effective from all three perspectives. Palliative care is cost-effective from provider and societal perspectives, but not from the patient perspective.
  
  
  CONCLUSIONS
  Prioritizing incorporation of patient preferences within guidelines holds good value and should be prioritized when developing new guidelines.
authors: a Department of Health Policy & Management , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors: William V
authors: WV
authors: Padula
authors: b Pritzker School of Medicine , University of Chicago , Chicago , IL , USA.
authors: M Andrew
authors: MA
authors: Millis
authors: c Section of Hospital Medicine, University of Chicago , Chicago , IL , USA.|d CareMore Health Plan , Las Vegas , NV , USA.
authors: Aelaf D
authors: AD
authors: Worku
authors: e Departments of Anesthesiology , Critical Care and Surgery, Johns Hopkins School of Medicine , Baltimore , MD , USA.
authors: Peter J
authors: PJ
authors: Pronovost
authors: a Department of Health Policy & Management , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors: John F P
authors: JF
authors: Bridges
authors: c Section of Hospital Medicine, University of Chicago , Chicago , IL , USA.|f Center for Health and the Social Sciences (CHeSS), University of Chicago , Chicago , IL , USA.
authors: David O
authors: DO
authors: Meltzer
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D057240:Patient Preference / Q000191:economics*; D018802:Patient-Centered Care / Q000191:economics*; D017410:Practice Guidelines as Topic; D019057:Quality-Adjusted Life Years; D013812:Therapeutics / Q000191:economics*
keywords: Patient preferences; cost-effectiveness analysis; guidelines; patient-centered care