A Method for Estimating the Cost- Effectiveness of Incorporating Patient Preferences into Practice Guidelines

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Abstract
Many clinical practice guidelines fail to account for the preferences of the individual patient. Approaches that seek to include the preferences of the individual patient in the decision- making process (e.g., interactive videodisks for patient education), however, may incur sub stantial incremental costs. Developers of clinical practice guidelines must therefore determine whether it is appropriate to make their guidelines flexible with regard to patient preferences. The authors present a formal method for determining the cost-effectiveness of incorporating the preferences of individual patients into clinical practice guidelines. Based on utilities assessed from 37 patients, they apply the method in the setting of mild hypertension. In this example, they estimate that the cost-effectiveness ratio for individualized utility assessment is $48,565 per quality-adjusted year of life, a ratio that compares favorably with other health interventions that are promoted actively. This approach, which can be applied to any clinical domain, offers a formal method for determining whether the incorporation of individual patient preferences is important clinically and is justified economically. Key words: cost-effective ness analysis; cost-utility analysis; utility assessment; decision analysis; practice guidelines; patient preferences. (Med Decis Making 1994;14:382-392)