The measurement of patients' values in medicine

Abstract

The standard gamble, derived from decision theory, is considered a criterion method for obtaining patients' values for different health states. In this method, a rater's value for a health state is obtained by determining, in a hypothetical setting, his readiness to remain in that state or take a risky choice with different outcomes of known value. According to the expected utility criterion, a rater's utility or value for a particular state should not be influenced by changes in the gamble outcomes. The standard gamble was used to obtain 64 patients' judgments of a set of health states, first with the outcomes of perfect health or death, and subsequently with other health states as outcomes. The changes in gamble outcomes significantly influenced reported values for health states, indicating that the standard gamble is internally inconsistent. This observation poses a major limitation to its use as a value measurement method in medicine.