Assessing Utilities: How Much Risk Are You Willing to Take?

When we are judging the cost-effectiveness of a treatment or intervention, we're really asking how much bang for the buck we're getting for our healthcare spending. That can be relatively easy when we're talking about life and death. But how do we measure improvements in quality? The most widely used method is through the use of utility values, and we'll show you how we calculate those in this week's Healthcare Triage.


John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics

[nilayjain]

is it just me or this is greatest most useful youtube channel. its literally demystifying healthcare. this should be played in every health class in the world.  

[sjwimmel]

*Video topic suggestion:* Interpreting statistics in scientific articles.
I've been trying to read some medical articles lately and I get confused by statistical terms like Odds Ratio, Confidence Interval and P-value. I have a sense of what they mean, but I can't really judge what an Odds Ratio of 1.23 means because I don't have context.

[RBuckminsterFuller]

I love this kind of thing. You do some very interesting research, Mr. Dr.!

[filippocatellani]

hi, i'm studying the utility cost analysis. I didn't understand the two methods very much! Very helpful! A thousand thanks

[johnharvey]

Thanks for writing and hosting such an informative and thought-provoking show, Doc.

[Energya]

Good explanation of the different methodologies there. Also, because of the dictionary you made, I feel like I'm watching medical science in progress, which is awesome! Be sure to keep us up to date on it!

[davcar]

Thank you very much for continuing to make quality videos. Keep up the great work.

[illyxxolicnaxim]

Very interesting, I wouldn't have thought of it that way. I'm training to be a doctor and this video, along with the rest of healthcare triage, is really opening my eyes to health care issues I hadn't considered. Thank you health care triage! : )

[benbarker]

I enjoy your videos because it provides interesting ways to examine routine dilemmas that medical folks have to wrestle with on a daily basis. I am not a doctor. I am not trained to think like a doctor. These videos help me understand how doctors process information when making medical decisions.

Would you be willing to do a video on end-of-life / palliative care options for kids?

[whheaton]

I really enjoy most of your videos. And I think that THIS issue is an incredibly important one. Having recently read the book "Stumbling on Happiness" by Daniel Gilbert, I feel like there might be some serious flaws in the "Standard Gamble" metric. It turns out that many people in situations that healthy people would find "worse than death" like quadriplegia etc are very happy. Now, when it comes up, I always point out that health care is already rationed and that the only decision to be made is how to make those rationing decisions. But if our goal is to maximize happiness years, then determining happiness by imagining scenarios is probably not a great measure. Instead we should give the standard gamble to people who actually have the diseases and disabilities in question as they are a much better judge of the lifestyle and "disability" (I use quotes because some of these such as blindness and deafness create communities that flourish and see themselves as different but not as having a disability). And many deaf or blind people given the choice would not "cure" their "disability". I don't pretend to understand any of this. It is mysterious and I still can't help but believe there is some level of happiness that such people don't feel or know about, or that some human states are universally better than others. But I repress those thoughts as the one thing I know for sure is that I don't know everything. I have not had all such experiences. Just some interesting stuff to throw in your spokes. Thanks for the videos. Keep it up!

[Aaron.Reichert]

Found a new YouTube channel. I really think I'm going to like.

[ghuegel]

Is it really worth it to spend two weeks on cost effectiveness?

[TheWinnipegredhead]

Really important topic so rarely discussed. Thank you.

[wayfareangel]

This made me really think. I'm in constant pain. Like, horrible pain. So bad it makes me physically ill. If something had a 50/50 chance of killing or curing me? I like those odds.

[allergiccookies]

as someone who probably spends about 5-10 minutes every month busy having seizures, I get that it's a hypothetical just for explaining, but I absolutely don't want your instant death pill! I don't care if it's one in a billion or one day! cars are so dangerous even for people without epilepsy, of course I don't want to drive one lol

[scott]

Nice to see the top of your head is back, Aaron. 

[LPSDave]

I had to make a decision RE: loss of life expectancy a few months ago. A longer life filled with pain that would get progressively worse the longer I lived or a shorter life potentially pain free. I chose the latter. There's a long enough time span in there that changes can be made and I can regain my full life expectancy. I'm not completely counting on that but I'm okay with dying sooner so I can live a normal life.

[seattlecathy]

What about living with more than an occasional seizure? Think of people in nursing homes with long-term, painful incurable conditions. Most end-of-life procedures  cost a lot and deliver little, yet people don't have an opportunity to opt out. Hospitals routinely override DNR orders when money is involved. 

[Mncdk]

Before watching the video, I just want to say that I literally threw my arms in the air with excitement that this will be covered for 2 weeks, as it suggests you are being extra thorough with what you make out to be a controversial topic.
In my mind, cost-effectiveness is insanely important. I get the whole playing god angle that people often point at, but like you said in the opener, spending a billion to increase lifespan by 1 day is a waste of money. Save a newborn or a young person with cancer instead.

[evilkinggumby]

this reminds me of the last season or so of The 4400 where they have a drug that could potentially turn you into one of the 4400 (so, potentially psychic or have powers) but it has a 50/50 risk of also killing the user. In the show a lot of people that felt like they had little to live for would do it. If you had a moderate seizure disorder, you would have to take into account their mental and emotional state and if those 'once a month' episodes were enough to taint their overall quality of life. That seems like ti could lead to a much different acceptable risk. Still, fascinating stuff.