Assessing the Importance of Treatment Goals in Patients with Psoriasis: Analytic Hierarchy Process vs. Likert Scales

• Published in: The patient : patient-centered outcomes research 2018-08, Vol.11 (4), p.425-437
• Main Authors: Gutknecht, Mandy, Danner, Marion, Schaarschmidt, Marthe-Lisa, Gross, Christian, Augustin, Matthias
• Format: Article
• Language: English
• Subjects: Adult; Aged; Clinical decision making; Decision making; Decision Support Techniques; Dermatology; Female; Germany; Goals; Health Administration; Health Economics; Hierarchies; Humans; Interpersonal Relations; Likert scale; Macular degeneration; Male; Medicine; Medicine & Public Health; Middle Aged; Original Research Article; Pain - etiology; Pain - psychology; Patient Outcome Assessment; Patients; Pharmacoeconomics and Health Outcomes; Pruritus - etiology; Pruritus - psychology; Psoriasis; Psoriasis - complications; Psoriasis - drug therapy; Psoriasis - psychology; Public Health; Quality of Life; Quality of Life Research; Questionnaires; Ratings & rankings; Self Efficacy; Skin; Stress, Psychological - etiology; Surveys and Questionnaires - standards; Well being; Young Adult
• ISSN: 1178-1653; 1178-1661
• DOI: 10.1007/s40271-018-0300-1

Background To define treatment benefit, the Patient Benefit Index contains a weighting of patient-relevant treatment goals using the Patient Needs Questionnaire, which includes a 5-point Likert scale ranging from 0 (“not important at all”) to 4 (“very important”). These treatment goals have been assigned to five health dimensions. The importance of each dimension can be derived by averaging the importance ratings on the Likert scales of associated treatment goals. Objective As the use of a Likert scale does not allow for a relative assessment of importance, the objective of this study was to estimate relative importance weights for health dimensions and associated treatment goals in patients with psoriasis by using the analytic hierarchy process and to compare these weights with the weights resulting from the Patient Needs Questionnaire. Furthermore, patients’ judgments on the difficulty of the methods were investigated. Methods Dimensions of the Patient Benefit Index and their treatment goals were mapped into a hierarchy of criteria and sub-criteria to develop the analytic hierarchy process questionnaire. Adult patients with psoriasis starting a new anti-psoriatic therapy in the outpatient clinic of the Institute for Health Services Research in Dermatology and Nursing at the University Medical Center Hamburg (Germany) were recruited and completed both methods (analytic hierarchy process, Patient Needs Questionnaire). Ratings of treatment goals on the Likert scales (Patient Needs Questionnaire) were summarized within each dimension to assess the importance of the respective health dimension/criterion. Following the analytic hierarchy process approach, consistency in judgments was assessed using a standardized measurement (consistency ratio). Results At the analytic hierarchy process level of criteria, 78 of 140 patients achieved the accepted consistency. Using the analytic hierarchy process, the dimension “improvement of physical functioning” was most important, followed by “improvement of social functioning”. Concerning the Patient Needs Questionnaire results, these dimensions were ranked in second and fifth position, whereas “strengthening of confidence in the therapy and in a possible healing” was ranked most important, which was least important in the analytic hierarchy process ranking. In both methods, “improvement of psychological well-being” and “reduction of impairments due to therapy” were equally ranked in positions three and four. In contrast to