Utilities for major stroke: results from a survey of preferences among persons at increased risk for stroke
Samsa, G. P., Matchar, D. B., Goldstein, L., Bonito, A., Duncan, P. W., Lipscomb, J., ... Weinberger, M. (1998). Utilities for major stroke: results from a survey of preferences among persons at increased risk for stroke. American Heart Journal, 136(4 Pt 1), 703-713.
BACKGROUND: Patient beliefs, values, and preferences are crucial to decisions involving health care. In a large sample of persons at increased risk for stroke, we examined attitudes toward hypothetical major stroke. METHODS AND RESULTS: Respondents were obtained from the Academic Medical Center Consortium (n = 621), the Cardiovascular Health Study (n = 321 ), and United Health Care (n = 319). Preferences were primarily assessed by using the time trade off (TTO). Although major stroke is generally considered an undesirable event (mean TTO = 0.30), responses were varied: although 45% of respondents considered major stroke to be a worse outcome than death, 15% were willing to trade off little or no survival to avoid a major stroke. CONCLUSIONS: Providers should speak directly with patients about beliefs, values, and preferences. Stroke-related interventions, even those with a high price or less than dramatic clinical benefits, are likely to be cost-effective if they prevent an outcome (major stroke) that is so undesirable