Sutphin J, DiSantostefano R, Leach CA, Hauber B, Mansfield C. Preferences, optimism, and numeracy: an exploration into the use of psychological patient-reported outcome instruments in a preference survey. Presented at the 2020 ISPOR Virtual Conference; May 19, 2020. [abstract] Value Health. 2020 May 1; 23(Suppl 1):S328. doi: 10.1016/j.jval.2020.04.094.

BACKGROUND: Correspondence between patient preferences and patient-reported outcomes (PROs) is of interest among researchers. Research indicates low optimism and numeracy may be associated with difficulty or lack of participation in making treatment-related decisions.

OBJECTIVES: We investigated whether low optimism and low self-reported numeracy were associated with evidence of difficulty making decisions in a discrete-choice experiment (DCE).

METHODS: Preferences for a treatment to delay type 1 diabetes were elicited using a DCE among 1,501 parents in the United States. Respondents chose between two hypothetical treatments or an opt-out (no treatment) in a series of choice questions. The survey included the Life Orientation Test– Revised (a measure of optimism) and the 3-item Subjective Numeracy Scale. We used random-parameters logit (RPL) models to test for differences in preferences across subgroups defined by PRO scores and 5-class latent class analyses where membership probability was predicted by PRO scores.

RESULTS: In RPL subgroup models, respondents with below median optimism had different and disordered preferences compared with high optimism (P = 0.000), but preferences of respondents with above median numeracy were not different compared with lower numeracy (P = 0.0714). Latent class analyses found those with lower optimism scores had a higher probability of membership in a class that chose opt-out and had disordered preferences (P value for optimism coefficient: P = 0.032). Those with lower self-reported numeracy were more likely to be in a class with a strong preference for the opt-out (P = 0.000) or a class with a preference for the opt-out and avoiding serious treatment-related risks (P = 0.015).

CONCLUSIONS: Two PROs helped identify differences in preferences in a DCE. If respondents with lower optimism and lower numeracy are more likely to choose an opt-out or have disordered preferences in a DCE, it may indicate that they have difficulty completing choice tasks.

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