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Effects of decision aids for menorrhagia on treatment choices, health outcomes, and costs: a randomized controlled trial

Kennedy, A.D.M., Sculpher, M.J., Coulter, A., Dwyer, N., Rees, M., Abrams, K.R., Horsley, S., Cowley, D., Kidson, C., Kirwin, C., Naish, C. and Stirrat, G. (2002) Effects of decision aids for menorrhagia on treatment choices, health outcomes, and costs: a randomized controlled trial. Journal of American Medical Association, 288 (21). pp. 2701-2708. ISSN 0098-7484

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Abstract

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.

Item Type: Article
Institution: The University of York
Academic Units: The University of York > Economics and Related Studies (York)
Depositing User: York RAE Import
Date Deposited: 07 May 2009 15:32
Last Modified: 07 May 2009 15:32
Published Version: http://dx.doi.org/10.1001/jama.288.21.2701
Status: Published
Publisher: American Medical Association
Identification Number: 10.1001/jama.288.21.2701
URI: http://eprints.whiterose.ac.uk/id/eprint/6483

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