A Study of Process Utility

Abstract
Background: This study compares the cost-effectiveness of using an online assessment tool (ePAQ) in advance of a face-to-face (control) versus a telephone (intervention) consultation. The trial suggests statistically significant differences between groups for three PEQ (Patient Experience Questionnaire) dimensions. However, it is unlikely that these differences were captured by the cost-effectiveness outcomes (Incremental cost/QALY). This is consistent with other work that has suggested the QALY does not capture all outcomes relevant to interventions, particularly where the outcomes are non-health outcomes e.g. associated with processes of receiving care.
Aim: With this issue in mind, the ePAQ trial was a vehicle for the exploration of process utility. The overarching aim was to utilise ePAQ trial data, to improve the relevance of the cost-effectiveness outcomes by incorporating process utility into the QALY.
Methods: This thesis includes: a literature review of process utility studies; a process utility bolt-on study; the application of the findings to ePAQ trial data; revised cost-effectiveness estimates incorporating process utility. Qualitative methods were used to explore participant’s reactions to health states including health and process outcomes.
Results: The valuation study captured process utility. The inclusion of process utility in the ePAQ EEACT moved the intervention from being dominated by the control, to a position where it falls within the willingness-to-pay threshold of £20,000/QALY, indicating its inclusion can impact on cost-effectiveness results. Respondents’ were able to value health and process scenarios within the think aloud study.
Conclusion: This study indicates that patients do care about both health and process outcomes. The valuation study provided a mechanism for capturing the amount of utility people have for these processes, however, the qualitative study raised questions on the validity of utility estimates derived from health and process scenarios. This thesis is an exploratory study, and highlights a need for further research into the topic.