Measuring health utility in varying pregnancy contexts among a diverse cohort of pregnant women

Lisbet S. Lundsberg, Xiao Xu, Eleanor Schwarz, Aileen M. Gariepy

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective To contribute to decision analysis by estimating utility, defined as an individual's valuation of specific health states, for different pregnancy contexts. Study design Cross-sectional analysis of data from pregnant women recruited at pregnancy testing clinics during June 2014–June 2015. Utility was measured using the visual analog scale (VAS), PROMIS GSF-derived utility, standard gamble (SG), and time-trade-off (TTO) approaches. Six dimensions of pregnancy context were assessed including: intention, desirability, planning, timing, wantedness, and happiness. Multivariable regression modeling was used to examine the associations between pregnancy context and utility while controlling for women's sociodemographic and health characteristics. Results Among 123 participants with diverse characteristics, aged 27±6 years, with mean gestation of 7.5±3 weeks, few reported optimal pregnancy contexts. Mean utility of the pregnancy state varied across contexts, whether measured with VAS (0.28–0.91), PROMIS GSF-derived utility (0.66–0.75), SG (0.985–1.00) or TTO (0.9990–0.99999). The VAS-derived mean utility score for unintended pregnancy was 0.68 (95% CI 0.59, 0.77). Multivariable regression analysis demonstrated significant disutility of unintended pregnancy, as well as all other unfavorable pregnancy contexts, when measured by VAS. In contrast, PROMIS GSF-derived utility only detected a significant reduction in utility among ambivalent compared to wanted pregnancy, while SG and TTO did not show meaningful differences in utility across pregnancy contexts. Conclusions Unintended pregnancy is associated with significant patient-reported disutility, as is pregnancy occurring in other unfavorable contexts. VAS-based measurements provide the most nuanced measures of the utility for pregnancy in varying contexts. Implications Decision analyses, including assessments of the cost-effectiveness of pregnancy related interventions, should incorporate measures of the utility of pregnancy in various contexts.

Original languageEnglish (US)
Pages (from-to)411-419
Number of pages9
JournalContraception
Volume96
Issue number6
DOIs
StatePublished - Dec 1 2017

Fingerprint

Pregnant Women
Pregnancy
Health
Visual Analog Scale
Decision Support Techniques
Happiness
Women's Health
Cost-Benefit Analysis
Cross-Sectional Studies
Regression Analysis

Keywords

  • London measure of unplanned pregnancy
  • Unintended pregnancy
  • Utility
  • Visual analog scale

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Measuring health utility in varying pregnancy contexts among a diverse cohort of pregnant women. / Lundsberg, Lisbet S.; Xu, Xiao; Schwarz, Eleanor; Gariepy, Aileen M.

In: Contraception, Vol. 96, No. 6, 01.12.2017, p. 411-419.

Research output: Contribution to journalArticle

Lundsberg, Lisbet S. ; Xu, Xiao ; Schwarz, Eleanor ; Gariepy, Aileen M. / Measuring health utility in varying pregnancy contexts among a diverse cohort of pregnant women. In: Contraception. 2017 ; Vol. 96, No. 6. pp. 411-419.
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abstract = "Objective To contribute to decision analysis by estimating utility, defined as an individual's valuation of specific health states, for different pregnancy contexts. Study design Cross-sectional analysis of data from pregnant women recruited at pregnancy testing clinics during June 2014–June 2015. Utility was measured using the visual analog scale (VAS), PROMIS GSF-derived utility, standard gamble (SG), and time-trade-off (TTO) approaches. Six dimensions of pregnancy context were assessed including: intention, desirability, planning, timing, wantedness, and happiness. Multivariable regression modeling was used to examine the associations between pregnancy context and utility while controlling for women's sociodemographic and health characteristics. Results Among 123 participants with diverse characteristics, aged 27±6 years, with mean gestation of 7.5±3 weeks, few reported optimal pregnancy contexts. Mean utility of the pregnancy state varied across contexts, whether measured with VAS (0.28–0.91), PROMIS GSF-derived utility (0.66–0.75), SG (0.985–1.00) or TTO (0.9990–0.99999). The VAS-derived mean utility score for unintended pregnancy was 0.68 (95{\%} CI 0.59, 0.77). Multivariable regression analysis demonstrated significant disutility of unintended pregnancy, as well as all other unfavorable pregnancy contexts, when measured by VAS. In contrast, PROMIS GSF-derived utility only detected a significant reduction in utility among ambivalent compared to wanted pregnancy, while SG and TTO did not show meaningful differences in utility across pregnancy contexts. Conclusions Unintended pregnancy is associated with significant patient-reported disutility, as is pregnancy occurring in other unfavorable contexts. VAS-based measurements provide the most nuanced measures of the utility for pregnancy in varying contexts. Implications Decision analyses, including assessments of the cost-effectiveness of pregnancy related interventions, should incorporate measures of the utility of pregnancy in various contexts.",
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