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Effects of Decision Aids for Menorrhagia on Treatment Choices, Health Outcomes, and Costs
A Randomized Controlled Trial
Andrew D. M. Kennedy, BSc;
Mark J. Sculpher, PhD;
Angela Coulter, PhD;
Nuala Dwyer, FRCOG;
Margaret Rees, FRCOG;
Keith R. Abrams, PhD;
Susan Horsley, RN;
Deborah Cowley, RN;
Christine Kidson, RN;
Catherine Kirwin, RN;
Caroline Naish, RN;
Gordon Stirrat, FRCOG
JAMA. 2002;288:2701-2708.
Context Decision aids can increase patient involvement in treatment decision making. However, questions remain regarding their effects and cost implications.
Objective To evaluate the effects of information, with and without a structured preference elicitation interview, on treatment choices, health outcomes, and costs.
Design, Setting, and Participants A randomized controlled trial with 2 years of follow-up. Between October 1996 and February 1998, 894 women with uncomplicated menorrhagia were recruited from 6 hospitals in southwest England. Women were randomized to the control group, information alone group (information), or information plus interview group (interview).
Interventions Women in both intervention groups were sent an information pack (a booklet and complementary videotape) 6 weeks before their specialist consultation. Immediately before their consultation, women in the interview group underwent structured interview, to clarify and elicit their preferences.
Main Outcome Measures Self-reported health status was the main outcome; secondary outcomes included treatments received and costs. Cost analyses adopted a UK health service (payer) perspective, and were based on patient-reported resource use data and are reported in 1999-2000 US dollars.
Results The interventions had no consistent effect on health status. Hysterectomy rates were lower for women in the interview group (38%) (adjusted odds ratio [OR], 0.60; 95% confidence interval [CI], 0.38-0.96) than in the control group (48%) and women who received the information alone (48%) (adjusted OR, 0.52; 95% CI, 0.33-0.82). The interview group had lower mean costs ($1566) than the control group ($2751) (mean difference, $1184; 95% CI, $684-$2110) and the information group $2026 (mean difference, $461; 95% CI, $236-$696).
Conclusions Neither intervention had an effect on health status. Providing women with information alone did not affect treatment choices; however, the addition of an interview to clarify values and elicit preferences had a significant effect on women's management and resulted in reduced costs.
Author Affiliations: Health Economics Research Group, Brunel University, Uxbridge, England (Mr Kennedy); Centre for Health Economics, University of York, York, England (Dr Sculpher); Picker Institute Europe, Oxford, England (Dr Coulter); Weston General Hospital, Weston-super-Mare, England (Dr Dwyer); John Radcliffe Hospital, Oxford, England (Dr Rees and Ms Naish); Department of Epidemiology and Public Health, University of Leicester, Leicester, England (Dr Abrams); Princess Margaret Rose Hospital, Swindon, England (Ms Horsley); St Michael's Hospital, Bristol, England (Ms Cowley and Dr Stirrat); Taunton and Somerset Hospital, Taunton, England (Ms Kidson); and St Paul's Hospital, Cheltenham, England (Ms Kirwin).
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