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Automated Computer Interviews to Elicit Utilities

Potential Applications in the Treatment of Deep Venous Thrombosis

Affiliations of the authors: Division of Clinical Pharmacology, Department of Medicine, Stanford University School of Medicine, Stanford, CA (LAL); Division of Gastroenterology, Department of Medicine, Stanford University School of Medicine, Stanford, CA (RMS).

Correspondence and reprints: Leslie A. Lenert, MD, Division of Clinical Pharmacology, Stanford University Medical Center, Room S169, Stanford, CA 94305. E-mail: lenert{at}camis.stanford.edu

Abstract Objective: To assess the practicality of an automated computer interview as a method to assess preferences for use in decision making. To assess preferences for outcomes of deep vein thrombosis (DVT) and its treatment.

Study Design: A multimedia program was developed to train subjects in the use of different preference assessment methods, presented descriptions of mild post-thrombotic syndrome (PTS), severe PTS and stroke and elicited subject preferences for these health states. This instrument was used to measure preferences in 30 community volunteers and 30 internal medicine physicians. We then assessed the validity of subject responses and calculated the number of quality-adjusted life years (QALYs) for each individual for each alternative.

Results: All subjects completed the computerized survey instrument without assistance. Subjects generally responded positively to the program, with volunteers and physicians reporting similar preferences. Approximately 26.5% of volunteers and physicians had preferences that would be consistent with the use of thrombolysis. Individualization of therapy would lead to the most QALYs.

Conclusions: Utilization of computerized survey instruments to elicit patient preferences appears to be a practical and valid approach to individualize therapy. Application of this method suggests that there may be many patients with DVT for whom treatment with a thrombolytic drug would be optimal.

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