Context effects in health state utility assessment: Etiology, framing, and delay of health outcomes.

Persistent Link:
http://hdl.handle.net/10150/185266
Title:
Context effects in health state utility assessment: Etiology, framing, and delay of health outcomes.
Author:
MacKeigan, Linda Dawn.
Issue Date:
1990
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
This research examined the effects of two aspects of health state context, etiology and delay in onset, on preferences for health states. Research questions about the effect of etiology were derived from regret theory and prospect theory, theories of behavioral decision making: (1) Does etiology (iatrogenic versus natural) affect utility for a health state? (2) Does framing iatrogenic morbidity as a transaction cost reduce its disutility? Research questions about delayed health outcomes were based on the theory of intertemporal choice: (1) Does time preference for health differ for health gains and losses? (2) Does the time preference difference between gains and losses apply to both short and long-term changes in health? Each contextual factor was investigated in a separate mixed factorial experimental design. Subjects were randomly assigned to rate three hypothetical health states described in one of three frames: unexplained loss of health, iatrogenic loss of health, or iatrogenic cost of overall health gain, and to evaluate either health gain or loss profiles in which the duration and delay of onset of the health change were manipulated. One hundred and eight volunteers were obtained from a university staff population, and outpatient and volunteer populations of a Veterans Affairs hospital. Data for both studies were collected in one hour interviews. Utilities for health states and health profiles were assessed with the standard gamble and the category rating scale respectively. Inferential tests of hypotheses were based on mixed factorial analyses of variance. In the framing study hypotheses were tested with planned comparison t tests; in the time preference study they were tested with F tests of double and triple interactions. Conclusions were that greater disutility is assigned to iatrogenic morbidity than to natural morbidity, that time preference for health gains differs from time preference for losses, and that devaluation of a delayed health loss is dependent on its duration. The theory of intertemporal choice was supported in the health domain. Conclusions cannot be extended beyond preferences elicited with hypothetical health scenarios. Lack of support for a framing effect for iatrogenic health states was attributed to inadequate statistical power.
Type:
text; Dissertation-Reproduction (electronic)
Keywords:
Economics.
Degree Name:
Ph.D.
Degree Level:
doctoral
Degree Program:
Pharmacy Practice.; Graduate College
Degree Grantor:
University of Arizona
Advisor:
Larson, Lon N.

Full metadata record

DC FieldValue Language
dc.language.isoenen_US
dc.titleContext effects in health state utility assessment: Etiology, framing, and delay of health outcomes.en_US
dc.creatorMacKeigan, Linda Dawn.en_US
dc.contributor.authorMacKeigan, Linda Dawn.en_US
dc.date.issued1990en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractThis research examined the effects of two aspects of health state context, etiology and delay in onset, on preferences for health states. Research questions about the effect of etiology were derived from regret theory and prospect theory, theories of behavioral decision making: (1) Does etiology (iatrogenic versus natural) affect utility for a health state? (2) Does framing iatrogenic morbidity as a transaction cost reduce its disutility? Research questions about delayed health outcomes were based on the theory of intertemporal choice: (1) Does time preference for health differ for health gains and losses? (2) Does the time preference difference between gains and losses apply to both short and long-term changes in health? Each contextual factor was investigated in a separate mixed factorial experimental design. Subjects were randomly assigned to rate three hypothetical health states described in one of three frames: unexplained loss of health, iatrogenic loss of health, or iatrogenic cost of overall health gain, and to evaluate either health gain or loss profiles in which the duration and delay of onset of the health change were manipulated. One hundred and eight volunteers were obtained from a university staff population, and outpatient and volunteer populations of a Veterans Affairs hospital. Data for both studies were collected in one hour interviews. Utilities for health states and health profiles were assessed with the standard gamble and the category rating scale respectively. Inferential tests of hypotheses were based on mixed factorial analyses of variance. In the framing study hypotheses were tested with planned comparison t tests; in the time preference study they were tested with F tests of double and triple interactions. Conclusions were that greater disutility is assigned to iatrogenic morbidity than to natural morbidity, that time preference for health gains differs from time preference for losses, and that devaluation of a delayed health loss is dependent on its duration. The theory of intertemporal choice was supported in the health domain. Conclusions cannot be extended beyond preferences elicited with hypothetical health scenarios. Lack of support for a framing effect for iatrogenic health states was attributed to inadequate statistical power.en_US
dc.typetexten_US
dc.typeDissertation-Reproduction (electronic)en_US
dc.subjectEconomics.en_US
thesis.degree.namePh.D.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplinePharmacy Practice.en_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorLarson, Lon N.en_US
dc.contributor.committeememberBootman, J. Lyleen_US
dc.contributor.committeememberDraugalis, JoLaine R.en_US
dc.contributor.committeememberBurns, Lawton R.en_US
dc.identifier.proquest9111951en_US
dc.identifier.oclc710365957en_US
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