REPLY
Health Values of the Seriously Ill
Joel Tsevat, MD, MPH;
David B. Matchar, MD; and
Albert W. Wu, MD, MPH
15 January 1996 | Volume 124 Issue 2 | Page 279
IN RESPONSE:
The time-tradeoff method is a standard value-preference-utility measure that ascertains the desirability of a state of health [1], in this case, the patient's own state of health. It is not necessarily a measure of the "‘value’ of their lives," as Dr. Letvak states. We do not believe that the time-tradeoff method is biased or leading [1]. Neither do we believe that preferences for cardiopulmonary resuscitation and for life-extending care even at the expense of pain and discomfort represent "true values" of life.
Aside from eliciting time-tradeoff utilities, we sought to determine their potential determinants. In response to Dr. Letvak's specific questions, time-tradeoff scores were related to a patient's concerns for the financial effect of the patient's illness on the family Table 2 in our report) but not to a patient's religion [2]. As our study and those of others have shown [3, 4], the determinants of health values are poorly understood but are crucial if we are to base clinical and health policy decisions on them [5]. We agree with Dr. Letvak's suggestion that qualitative research involving in-depth, open-ended interviews with fewer patients might help researchers, clinicians, and policymakers elucidate what groups of patients value most. For an individual patient, however, attempts to predict values and preferences based on a mathematical model or a surrogate decision maker's belief are no substitute for directly eliciting a patient's values and preferences.
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Author and Article Information
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University of Cincinnati Medical Center; Cincinnati, OH 45267
1. Torrance GW. Measurement of health state utilities for economic appraisal: a review. J Health Econ. 1986; 5:1-30.
2. Tsevat J, Cook EF, Green ML, Matchar DB, Dawson NV, Broste SK, et al. Health values of the seriously ill. Ann Intern Med. 1995; 122:514-20.
3. Revicki DA, Kaplan RM. Relationship between psychometric and utility-based approaches to the measurement of health-related quality of life. Qual Life Res. 1993; 2:477-87.
4. Tsevat J, Solzan JG, Kuntz KM, Ragland J, Currier JS, Sell RL, et al. Health values of HIV-infected patients: relationship to mental health and physical functioning. Med Care. (In press).
5. Tsevat J, Weeks JC, Guadagnoli E, Tosteson AN, Mangione CM, Pliskin JS, et al. Using health-related quality-of-life information: clinical encounters, clinical trials, and health policy. J Gen Intern Med. 1994; 9:576-82.
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