Do clinicians always maximize patient outcomes? A conjoint analysis of preferences for carotid artery testing

Journal of Health Services Research & Policy
Franco Sassi, Martin McKee

Abstract

The value clinicians place on diagnostic information is subject to psychological influences and systematic biases, but there is limited evidence of how these factors may affect patients' health outcomes. We assessed the relative value attached by experienced clinicians to different diagnostic test characteristics and how their preferences relate to patient outcomes, focusing on strategies for testing symptomatic patients for carotid artery stenosis. Using conjoint analysis, experienced neurologists and vascular surgeons ranked 10 diagnostic strategies defined in terms of four characteristics. Clinicians' preferences were analysed using an ordered probit model and compared with those obtained using a risk neutral expected value (EV) model developed to predict the consequences of each strategy as if the clinicians' sole goal were to optimize patient outcome. Results were tested for internal consistency and robustness to key model assumptions. Preferences for positive predictive value (PPV), relative to negative predictive value (NPV), elicited from the clinicians diverged substantially from those estimated by the EV model based on 5-year stroke-free survival (ratios of -0.8 and -32.8, respectively). Conversely, preferences for NP...Continue Reading

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Citations

May 3, 2013·Applied Health Economics and Health Policy·A Brett HauberF Reed Johnson
Jan 23, 2016·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Axel MühlbacherMark Belger
Oct 27, 2016·Arthritis Care & Research·Jaap FransenWilliam J Taylor

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