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Introduction Mobility limitations have a multitude of different negative consequences on elderly patients including decreasing opportunities for social participation, increasing the risk for morbidity and mortality.
However, current healthcare has several shortcomings regarding mobility sustainment of older adults, namely a narrow focus on the underlying pathology, fragmentation of care across services and health professions and deficiencies in personalising care based on patients’ needs and experiences. A tailored healthcare strategy targeted at mobility of older adults is still missing.
Objective The objective is to develop multiprofessional care pathways targeted at mobility sustainment and social participation in patients with vertigo/dizziness/balance disorders (VDB) and osteoarthritis (OA) .
Methods Data regarding quality of life, mobility limitation, pain, stiffness and physical function is collected in a longitudinal observational study between 2017 and 2019. General practitioners (GPs) recruit their patients with VDB or OA.
Patients who visited their GP in the last quarter will be identified in the practice software based on VDB and OA-related International Classification of Diseases 10th Revision. Study material will be sent from the practice to patients by mail. Six months and 12 months after baseline, all patients will receive a mail directly from the study team containing the follow-up questionnaire. GPs fill out questionnaires regarding patient diagnostics, therapy and referrals.
Ethics and dissemination The study was approved by the ethical committee of the Ludwig-Maximilians-Universität München and of the Technische Universität Dresden. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Results will be disseminated via newsletters, the project website and a regional conference for representatives of local and national authorities.
Objective. The authors performed a methodological comparison of the usual standard gamble with methods that could also be used in mailed questionnaires.Methods.Ninety-two diabetic patients valued diabetes-related health states twice. In face-to-face interviews, the authors used an iterative standard gamble (ISG) in which the probabilities were varied in a ping-pong manner and a self-completion method (SC) with top-down titration as search procedure (SC-TD) in 2 independent subsamples of 46 patients. Three months later, all patients received a mailed questionnaire in which the authors used the self-completion method with bottom-up (SCBU) and SC-TD as search procedures.Results.ISG and SCTD showed feasibility and consistency in the interviews. The ISG resulted in significantly higher utilities than the SC-TD. Two thirds of the mailed questionnaires provided useful results indicating some problems of feasibility. Utilities measured by SC-BU and SC-TD did not differ significantly showing procedural invariance. Further, patients indicated ambivalence when given the choice not to definitely state their preferences.Conclusions.The results show that different strategies to collect standard gamble utilities can yield different results. Compared with the usually applied ISG, the SC method is feasible in interviews and provides a consistent alternative that is less costly when used in mailed questionnaires, although its practicability has to be improved in this later setting.
For cost–benefit analysis, health technologies with multiple effects should be valued in a single scenario by a holistic willingness‐to‐pay (WTP) measure. Recent studies instead used decomposed scenarios in which respondents report their WTP for each individual effect. Evidence can be found that the sum of such decomposed WTPs overestimates the holistic WTP, i.e. the holistic WTP is sub‐additive. This sum of decomposed WTPs can lead to wrong conclusions on the efficiency of health technologies. This is also relevant in decision making about new technologies that are valued separately in different surveys. To date, no utility‐theoretical and empirically validated aggregation function for decomposed WTPs exists. Within an expected utility model, this paper identifies as a reason for sub‐additivity – beside risk aversion with respect to wealth – a negative influence of better health on the marginal utility of wealth, i.e. marginal utility of wealth is smaller in better health states. Assuming mutual utility independence of health and wealth, a theoretically founded aggregation function covering these two impacts is derived. In a contingent valuation study, 92 patients with diabetes were asked to state their WTP for reductions of the risk of several diabetic complications in decomposed as well as in holistic scenarios. The patients had preferences with a significant negative influence of health on the marginal utility of wealth. Sub‐additivity occurred and theoretically founded aggregation could considerably lower the degree of overestimation. These results suggest that the theoretically founded aggregation function might reduce problems of sub‐additivity that can be economically relevant. Further empirical testing of the approach is indicated.