Evaluating preferences for long term wheeze following RSV infection using TTO and best-worst scaling
Bibliographic record
Abstract
Respiratory Syncytial Virus (RSV) infects 70% of infants under one year, and is a leading cause of infant bronchiolitis-related hospitalizations [ 1 , 2 ]. RSV is a relatively benign, temporary condition, and therefore likely to have limited impact on quality adjusted life years, however, it has potential for long-term consequences such as asthma and wheeze [ 3 , 4 ]. Preferences related to the trade-offs between different long and short term aspects of RSV have not been explored previously, however, deriving preferences for infant health states is very challenging as infants require proxy elicitation of preferences [ 5 – 8 ]. The objectives of this study were to explore preferences surrounding attributes of RSV using proxy- and self-perspectives. Time trade-off (TTO) and best-worst scaling were used to derive utilities for health states of RSV and determine relative preferences for different levels of disease attributes. Vignettes were constructed from focus group data and expert opinion. Respondents were randomized to either a child perspective (“imagine that your child has RSV”), or an adult perspective (“imagine that you have RSV”). Experimental design for the BWS was developed using Sawtooth Software. 1000 Canadians were recruited through a market research panel facilitating a societal perspective. Five attributes were used – hospitalization status, oxygen support, presence of tubes (IV/NG), breathing symptom severity, and risk of long term wheeze. Ethics approval was obtained from the UBC BREB. Respondents completed both TTO and BWS tasks. Disutility associated with the short term health state of RSV was significant. Disutility followed an expected gradient, with more time traded for more severe RSV, and less time traded for less severe RSV (mean range: 0.57 – 0.14). Utilities were lower in the child perspective than the adult perspective. 0% risk of long term risk of wheeze was most preferred over all other attributes, and respiratory failure was least preferred (-4.7). Strong negative preferences were similar for IV/NG (-3.3), ICU admission (-3.5), mechanical ventilation (-3.6), and severe breathing problems (-3.6). Utility associated with risk of wheeze became lower as risk increased, with a relative preference for 80% risk of wheeze (-2.8) between moderate (-1.5) and severe (-3.7) breathing problems. Preferences indicate societal willingness to accept immediate, short term, potentially clinically significant consequences to avoid long term risk of wheeze. This study provides utilities that can be utilized for the evaluation of any potential or proposed treatment of RSV in children, and is important to understanding and applying priorities in health care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".