The danger of applying group-level utilities in decision analyses of the treatment of localized prostate cancer in individual patients

Mark E. Cowen, Brian J. Miles, Daniel F. Cahill, R. Brian Giesler, J. Robert Beck, Michael W. Kattan

Research output: Contribution to journalArticle

55 Scopus citations

Abstract

The optimal management strategy for men who have localized prostate cancer remains controversial. This study examines the extent to which suggested treatment based on the perspective of a group or society agrees with that derived from individual patients' preferences. A previously published decision analysis for localized prostate cancer was used to suggest the treatment that maximized quality-adjusted life expectancy. Two treatment recommendations were obtained for each patient: the first (group-level) was derived using the mean utilities of the cohort; the second (individual- level) used his own set of utilities. Group-level utilities misrepresented 25-48% of individuals' preferences depending on the grade of tumor modeled. The best kappa measure achieved between group and individual preferences was 0.11. The average quality-adjusted life years lost due to misrepresentation of preference was as high as 1,7 quality-adjusted life years. Use of aggregated utilities in a group-level decision analysis can ignore the substantial variability at the individual level. Caution is needed when applying a group-level recommendation to the treatment of localized prostate cancer in an individual patient.

Original languageEnglish (US)
Pages (from-to)376-380
Number of pages5
JournalMedical Decision Making
Volume18
Issue number4
DOIs
StatePublished - 1998

Keywords

  • Decision analysis
  • Patient preferences
  • Prostate cancer
  • Utility assessment

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Informatics
  • Health Information Management
  • Nursing(all)

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