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Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 13, Issue 2, 2010. Pages: 65-72
Published Online: 30 June 2010

Copyright © 2010 ICMPE.


 

PERSPECTIVES
Should ‘‘Standard Gamble’’ and ‘‘Time Trade Off’’ Utility Measurement Be Used More in Mental Health Research?

Chris Flood*1

1RGN, RN (MH), BSc, MSc., Lecturer in Mental Health City University and Evaluation Manager, National Patient Safety Agency, National Health Service, UK.

* Correspondence to: Mr Chris Flood, School of Community and Health Sciences Alexandra Building, Philpot Street, London E1 2EA, UK.
Tel.: +44-20-7040 5989
Fax: +44-20-7927 9501
E-mail: c.flood@city.ac.uk

Source of Funding: None declared.

Abstract

This paper describes and reviews some of the difficulties of utility measurement in mental health research. Despite reluctance to use these methods examples exist of successful use. Utility measurement should be conducted with improved research methodology and design. These include better involvement of service users in the design stage, the changing of time frames offered to users, a greater need for comparative work and more staff training in the use of utility methodology with service users. Standard gamble and time trade off derived utilities have implications for resource allocations, decision making, health economics research and policy making. Institutions involved in decision making like the United Kingdom’s National Institute for Health and Clinical Excellence, would be better served in their decision making and calculating Quality Adjusted Life Years if more utility measurement was carried out. Other arguments for utility measurement include the desirability of eliciting a patient dimension of risk.

 

Background: This review and discussion paper demonstrates that utility and preference measurement in mental health research is increasing. However there is still a general reluctance around using the methods due to methodological challenges and concerns around the capacity of users to understand utility methods during the research process.

Aims of the Study: This paper sets out to describe and review some of the previously documented difficulties of using utility measurements in mental health services research and to highlight where they have been used successfully as measures. Additionally the paper aims to discuss a means of improving the methods used to capture service user utility and preference measurement and why decision making would be better informed as a result.

Methods: International literature on utility measurement is reviewed, specifically examining the use of standard gamble and time trade off methods in mental health.

Results: Utility measurement in mental health is increasing though as the review demonstrates, concerns still exist over its application. A number of methods can be used to improve the approach overall and these are discussed as well as specific areas worthy of utility measurement including `disutility' of admission, medication and medication side effects.

Discussion and Limitations: Overall this paper argues that it is necessary to persist with efforts to conduct utility measurement calculation albeit with a critical eye on the methods in an attempt to ensure improvements are continually made. Utility and preference scores may be limited in that they only provide a rough score but they are defended as a means of providing some form of strength of preference for health states. The review is limited to English only texts.

Implications for Health Care Provision: The debate on whether to use standard gamble and time trade off has implications for health services resource allocations, decision making, health economics research, policy making and health services research generally involving psychiatric service users. The paper argues that the absence of utility measurement in mental health runs the risk of mental health being disadvantaged in decisions around resource allocation.

Implications for Health Policies: Institutions involved in decision making like the United Kingdom's National Institute for Health and Clinical Excellence, would be better served in their decision making and calculation of Quality Adjusted Life Years if more utility measurement in psychiatric research was carried out. Other arguments for using utility measurement include the desirability of using utility measurement to elicit a patient dimension of risk.

Implications for Further Research: Future utility research should aim for better involvement of service users in the design stage, the changing of time frames offered to users in health state scenarios used, a greater need for comparative work of utilities scoring across illness and between standard gamble and time trade off and more staff training in the use of utility methodology with mental health service users.


Received 12 May 2009; accepted 26 March 2010

Copyright 2010 ICMPE