Assessing Utilities: How Much Risk Are You Willing to Take?
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- เผยแพร่เมื่อ 14 มิ.ย. 2024
- 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.
For those of you who want to read more, go here: theincidentaleconomist.com/wor...
John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics
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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.
Thanks for writing and hosting such an informative and thought-provoking show, Doc.
*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.
I love this kind of thing. You do some very interesting research, Mr. Dr.!
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!
Thank you very much for continuing to make quality videos. Keep up the great work.
hi, i'm studying the utility cost analysis. I didn't understand the two methods very much! Very helpful! A thousand thanks
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! : )
Great video, thanks Aaron!!
Really important topic so rarely discussed. Thank you.
I really enjoyed this video, and I'm really looking forward to the next one. Thanks for doing this! :)
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?
wow that was some stunning editing work
Found a new TH-cam channel. I really think I'm going to like.
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
Nice to see the top of your head is back, Aaron.
He's still not centered but better.
Very interesting series.
That was clearly explained and i completely understood the concepts you presented. Cheers :D
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.
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!
I also suspect that those who are in the situation for some time and those trying to put themselves in the shoes would give significantly different values, on average.
I don't know if it would apply to hypothetical life gambles, but I also think of the game-psych angle that our perception of punishment and reward aren't equivalent to us in terms of motivation. Most of the time, most people find less predictable rewards more compelling, but prefer to engage with a context of more predictable loss. Say, e.g. the comparitive popularities in an option between a risky and a conservative gamble (free, monetary and with equal average outcome) if the money to bet is put in one's hands beforehand and descibed as "yours", compared to if only the resulting cash is presented afterwards.
Most of the replies are from people who have no chronic illnesses and therein lies the problem. hey have no idea what the hell they're talking about so for them it's like "Fuck the sick people! Let them not have their medicine. I'm not going to pay for it...blablabla" I'd like to hear what they say after the doctor tells them they have a chronic condition and let them see first hand how financially ruinous it is. They have NO clue and it's terrifying that they're going to be the future policy makers; selfish and self centered and TERRIFYING.
Thanks, this video clearly explained time tradeoff!
This is just a perfect explanation
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.
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.
this was a good one
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.
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.
Is it really worth it to spend two weeks on cost effectiveness?
Yes, very important to understand why some treatments are available and others are. Thus making more people able to protest and discuss if one should be available in a fashionable matter.
Aksel Ladegaard What about three weeks on cost effectiveness, would you prefer that to two?
Yes I would other Ghuegel
Wait a minute or less
2 weeks is just 2 episodes no? It's not that much!
I think the topic of risk benefit is very interesting in the world of healthcare ethics. I find it interesting how we have come up with ways to quantify things like life to judge whether someone is suitable for a surgery. He also brings up another point that I find very interesting for this subject and that is how everyone has a different view towards risk-benefit some people are willing to take much more risk for a benefit compared to others. There are several interesting topics from my health ethics class that we have discussed that have different views of this. For example different medical studies that occur around the globe. These studies differ in subjects ranging from minor diseases to sever diseases. It is interesting to see how people with these diseases will take the risk of being part of the research even if it could lead to sever repercussions that others would view as way beyond there acceptable amount of risk. It is easy to say that when you are not one living with that disease but to those who have it the possibility of a view more years of improved life is worth that risk. Again I just find it interesting how this view differs between people and how we manage to quantify things like the quality of someone’s life.
Hey I'm an IU grad. and I wrote a book called EIGHT DAYS IN AN INNER CITY SCHOOL.
Question: Do the two methods of determining utility values equal? That is to say, if someone would give up 10 years out of 100 years, would they also accept a 10% chance of instant death? (assuming I did the math right on that)
I like this! Thanks HCT :)
As someone with a "moderate" seizure disorder... and having to put up with the already horrific side effects of the already craptrastic anti epileptic medication I'm on that could already shut down my liver, destroy my bones or just kill me anyways. Oh, and what about the fact tbat people with Epilepsy and seizure disorders have a higher mortality rate than normal people due to SUDEP. We are dying either way, pills or no pills. Epilepsy kills more people than breast cancer each year and yet which gets more awareness? I would love to get my licence back, climb ladders, have a bath and ride a bike... but not at the expense at cutting my life any further than it is. I'm walking on egg shells as it is. Ugh.
If I understood the hypothetical example in the video correctly, the pill would completely cure you from having seizures, so SUDEP would no longer apply. The only cut to your life would be from the pill.
You seem to be missing the point. That example was not to describe a specific treatment for moderate seizure disorder, but using a moderate seizure disorder as an example to explain ways of calculating how much risk potentially getting rid of the disorder is worth. It's oversimplified and doesn't reflect the complexity of real-life treatments, but that's the point of the exercise. It introduces an uncomplicated, black-and-white situation so that it can effectively gauge how much you'd be willing to risk for a hypothetical perfect cure.
I dont know much about seizures, but I'd take that 20years cut if it meant living 20years of my life on my terms instead of 40years dependent on the seizures.
Of course, that doesnt factor in the gamble that there could be a pill that comes out 20years and 1day that completely cures seizures with no side-effects.
I don't think Jessica was necessarily missing the point. Probably just commenting on having a reaction to the oversimplified example in the video because she (?) has a disorder that is a daily hardship and that doesn't get much attention. I wonder if Healthcare Triage could eventually do a segment on epilepsy because I don't know much about it but I do know that neurological disorders in general are very misunderstood or stigmatized
I was quick to comment, but my point was that his Utility value was off when comparing a "moderate seizure disorder" in reality because of other factors like SUDEP and other real world factors. I've been in 4 comas in my life because of Status seizures and daily struggles with tonic clonic seizures. I would love for any of the TH-cam channels to cover an Epilepsy episode. Epecially for Epilepsy day coming up (March 26th!)
Can you do a video on the effectiveness of chiropractic treatment.
Thankyouuuuuuu
Interesting serie! I always try to have this kind of discussions while it sounds harsh its the only way i think modern health care would survive in a public healthcare system.
Time trade off measures 'value' as opposed to 'utility' because the patient is choosing between two certain outcomes (no risk involved in the decision-making process, therefore it cannot be called utility)
Those are interesting ways of assessing utility value. Is utility value using standard gamble almost always higher than the time trade off? It seems that the years now are more valuable than the years at the end of your life, both because of humans' intrinsic discount rate, which I assume applies to time as well as money, and because the years at the end of your life could be of much lower quality than the ones now (in addition to that quality being uncertain).
And thanks 🙏 I did not see you this morning I was wondering how much is the weekend for tomorrow and thanks 😊 is the weekend so we were wondering if
Is it true that you are supposed to drink 8 glasses of gravy a day?
This is an important topic, but ultimately, value is always subjective. Everyone needs to make these decisions for themselves; though being informed about methods of risk assessment can help a lot of people.
That's why you get a bigger sample size than 1 d:
ResentIt Are you saying that your values about whether to live a longer life or to have a higher quality life are less important if 7 billion people disagree with you?
Most people accept that the decision to kill an innocent person cannot be democratically decided; and I see no reason to consider shortening a person's life or extending their suffering any different.
George Cataloni I think this is in the context of the public purse. While of course it's the patient's final decision, unfortunately they cannot also be the only one in charge of the pursestrings if it's not their bill.
If the patient funds it themselves, the method would have to be politically controversial for goverment to stop a life-extending treatment.
yewskriimskoop I don't recall Dr. Carroll saying anything about public payments. His video included a 1-on-1 chat with himself about his personal values; it doesn't seem like he's going in the direction of "This is what single payer systems should do.", especially because he lives in a country that doesn't have a single payer system. If that is the topic, you'd think he'd have mentioned it by now.
George Cataloni Ah, sorry, it was in the context of effectiveness of coverage in general: "If I had pill that extend your life by one day but it cost a billion dollars, it's unlikely that many people would argue that health insurance should pay for it."
The importance of the information is helpfulness to the insurers (public or private) in effectiveness of successfully funding what the studied (hypothetical clients) would expect of them. Because the money towards the insured is not an individual's collection, it would have rules and they need to be informed to be effective to the insured as a whole, not just whoever gets the pill first.
I really wanted to read the published article..but my school's Science Direct does not have open access to the journal :(
What if you could read the article, but it shortened your life by a year?
Hasnep
hmm...would i get to read other articles or just the one?
testing2488 Sure, any of the journal's articles for the rest of your life.
Hasnep
sounds like a good deal..where do i sign up?
testing2488 Errr... It doesn't work like that, It's hypothetical. I'm trying to find the- Oh never mind, go to www.readthearticlefromthehealthcaretriageepisode.com
What was the population you asked? I imagine, for example, parents of a healthy child vs. Parents of a child with severe MR would have wildly different utility values.
Moderately creeped out by the mention of a moderate seizure disorder so soon after finding out I might have one
It strikes me as problematic to ask people what sort of trade-off they think they'd make as though it represents the trade-off they actually would make in that situation. People are pretty terrible at predicting things like that.
You should do a video to clear up ignorance on herpes. many of us who suffer from the disease don't know all the ins and outs of how the disease is spread and how to deal with it once you get it. Millions of Americans suffer from it and I think many of them don't know the complete implications of the disease. thanks :)
@3:33 are we assuming no chance of resuscitation?
There was a typo at 4:06.
The difference is, that is some countries, if that pill was discovered, the state would go and bulk buy the recipe in order to make the pill 100$ for their citizens.
Now has was the way we were in this world we had the best experience ever we were the best in our experience and so glad I got the opportunity to experience the experience of this location
Thanks 🙏 was a time of weekend for the next weekend we were working tomorrow so I would have to come tomorrow or tomorrow I could come over tomorrow if
I have almost that exact hypothetical seizure disorder. (My doctor and I have given it this cool nickname: epilepsy.) And I'd take the gamble around exactly what he said.
Imho I think all those utility values Should be much closer to 1. Who would take a 7% chance of dying to get rid of allergies or a 9% chance of dying to get rid of some hearing loss. I wouldn't take a 9% chance of dying is I was out and out deaf.
Agreed, and it seems like most of the channels doing this are related to each other: Crash Course and HCT are produced by the same folks I believe.
If you're talking about the clone thing, Crash Course Politics only does that because that's Craig's usual vlogging style. :P It's been a running theme that he has various "clones" of himself living in his house for years.
It's also a way of keeping production costs low. Instead of having to find someone else who will play one of the parts, the same person wearing different clothes plays different parts. Craig/Wheezywaiter and his multiple clones, pro-net neutrality Hank and anti-net neutrality Hank, Mr Green and Me (John Green) from the Past, and now Dr Carroll and patient Carroll.
Cold, Dr. Carroll?
Actually I think cost effectiveness and quality of life are still way to underrated in health care.
Both are complicated topics on an ethical and scientific level but worth debating. On to we run into another dillema:
While money is objective value is subjective. $10k for a middle class child is a lot of money. For a 60 year old executive not so much. However curing a Child that will contribute to society is much more efficient than saving a sonn pensioner.
Another interesting point is to reverse the standard gambling scenario: Without treatment you will die in X years but you can get treatment that has a side effect and prolongs your life by Y.......
Was this just an extensive plug for your paper? :P
For the good he does with a) the channel and b) making a paper that helps humanity...yes, he deserves to plug his own paper :D
Oh to true.. Just thought I'd mention it
It certainly wasn't JUST a plug for the paper.
Based on table 4:
5% would give up 26% of their kids life span to avoid 10 days hospitalisations?!?!?!.... I am so confused about this.
I am also confused about how manny of these things have a median of 1... Though I assume that is because manny people does not wanna risk their child life or life span.
I'd say get the generic brand but that's like prescribing placebos.
Master Chief went to IU?
Why do all of you hate my video
you should really learn how to make good clones from craig benzine from wheezy waiter for things like this episode...
Seems like there are a lot of biases going on in this process?
Do you seriously only have a green and black jacket? Contrast please.
2nd
Luv clones
it should be criminal for these companies to charge so much for pills.
then don't buy them. you have no clue how much effort goes into making real medicine. do you want scientists, clinicians, doctors, quality assurance specialists, and their army of support staff to work for free?
and what happens to so many of these treatments or therapies ? down the road, they have some problem that never showed up during testing, and the company gets sued billions of dollars even though they might have honestly done nothing wrong.
Developing and bringing to market a drug product requires hundreds or thousands of science professionals over 5 to 20 years. Take a simple ballpark calculation:
100 scientists x $100,000/yr x 10 years = $100 million.
If you sell 1 million pills over the course of the drug, to simply recoup your pipelines R&D expense, you'd have to charge $100 per pill.
That's before you pay for facilities, manufacturing, distribution, marketing, regulatory affairs, and absorb the risk of loss or lawsuit.
I still agree though... I wish that treatment costs were much, much lower.
C0nc0rdance I've heard that if you wish hard enough, it'll come true. I've heard a lot of things.
MindLaboratory Strawman argument. Wishing medicine was less expensive =/= wishing it was free.
*Moves uncomfortably in seat* This is why economics makes me uncomfortable. I still love this show just, ugh.
$25,000 year for 40 years to pay the pills? Only if you are making easy money or your rich or somebody's paying for you then it's cost effect. But if you have to work like very hard for that, hell, prefer the going to sleep never wake up again.
It dependes, if you enjoy your job and your coworkers, then working 16hrs a day to pay for such a pill makes sense.
What is a persons value to society? is society willing to pay that much to maintain that persons value? Is society willing to pay that much to reduce the cost of not doing it?
Ask these question instead: What make up and Who are the society? Who are contribute, who are not contribute, and who are not only not contribute but taking advantage of those who contribute to the society?
Always good to be in the position of taking in only. For a fair good society, there must be a balance of contribution and consumption. .
What about Obama's death panels?
You come up with this utility index by asking hypothetical questions? How can that be accurate? Any economist will tell you there is a big difference between what people say they are willing to spend and what they actually spend in practice. Don't listen to what people say. Watch what they do.
Aaron clones!