Comparison of preferences for health outcomes in schizophrenia among stakeholder groups p Tina T. Lee a , Jennifer K. Ziegler b , Roger Sommi c , Catherine Sugar d , Ramy Mahmoud e , Leslie A. Lenert f, g, * a Department of Psychiatry, Veterans Aairs Palo Alto Healthcare System, USA b Stanford University Medical School, Stanford, CA, USA c Western Missouri Mental Health Center, University of Missouri, Kansas City, MO, USA d Department of Statistics, Marshall School of Business, University of Southern California, CA, USA e Janssen Research Foundation, USA f Health Services Research and Development Unit, Veterans Aairs San Diego Healthcare System, San Diego, CA, USA g Department of Medicine, University of California, San Diego, CA, USA Received 16 August 1999; received in revised form 21 January 2000; accepted 31 January 2000 Abstract Background: To determine the eectiveness of psychiatric interventions for use in cost-eectiveness analysis, we assessed the feasibility of using a multimedia computer survey to study preferences (utilities) for health outcomes among persons with schizophrenia, family members of persons with schizophrenia, health professionals, and the public. Methods: We developed videos depicting two patterns of mental health impairment in schizophrenia, both with and without pseudo-parkinsonism side-eects. These descriptions were integrated into a computer program that measured preferences using two psychometric methods: (1) standard gamble and (2) a visual analog scale. This program was used to compare preferences among potential stakeholder groups. Results: 20 persons with schizophrenia, 11 family members, 20 healthy volunteers and 14 health professionals participated in the computerized interview. All but one subject completed the survey. The correlation among ratings of various states was high (r = 0.7±0.95) and ratings were internally consistent in 89% of participants. There were signi®cant dierences in values between groups for health states ( p = 0.024) and in values for the eects of pseudo-parkinsonism on quality of life ( p < 0.001). Persons with schizophrenia valued the disease states more highly and placed more signi®cance than did other groups on the eects of pseudo-parkinsonism on quality of life. Conclusions: Computer-based multimedia techniques can oer a feasible and valid approach to measure preferences for outcomes in schizophrenia. The study found signi®cant dierences in preferences among stakeholder groups for schizophrenia outcomes. Further work is needed to clarify how these dierences aect clinical decision-making and policies for health resource allocation. Published by Elsevier Science Ltd. Keywords: Schizophrenia; Outcomes; Utilities; Preferences; Multimedia; Quality of life; Health states; Computers; Cost-eectiveness analysis 1. Introduction As health care dollars tighten, there is more interest in the determination of the eectiveness of psychiatric interventions. Assessments of the ecacy of anti-psy- chotic drugs have typically been performed using symptom rating scales (Overall and Gorham, 1962; Journal of Psychiatric Research 34 (2000) 201±210 0022-3956/00/$ - see front matter Published by Elsevier Science Ltd. PII: S0022-3956(00)00009-1 www.elsevier.com/locate/jpsychires p This manuscript was presented in part at the Annual Meeting of the Society for Medical Decision Making, Houston, Texas, 25±29 October, 1997. * Corresponding author. Tel.: +1-858-552-4325; fax: +1-858-552- 4321. E-mail address: llenert@ucsd.edu (L.A. Lenert).