The Northeastern Society of Plastic Surgeons

Back to 2017 Program


Parents Show Little Concern for Pediatric Bladder Dysfunction Based on Health Utilities
Benjamin M. Whittam, M.D., M.S., Konrad M. Szymanski, M.D., M.S., Shelly King, R.N., C.P.N.P., Mark P. Cain, M.D., William E. Bennett, Jr., M.D., M.S..
Indiana University School of Medicine, Indianapolis, IN, USA.

BACKGROUND: Health utilities are a rough estimate of the severity of a disease from the perspective of the patient or family. Clinical utilities range from death (0) to perfect health (1), with the relative "disutility" of a specific disorder lying somewhere between. These utilities are used determine Quality Adjusted Life Years (QALYs) for a variety of health states. As a basis for comparison, the previously determined pediatric utility for otitis media is 0.97 and severe intellectual impairment is 0.51, suggesting minimal concern regarding otitis, but major concern regarding mental impairment. Most health utilities in pediatrics, and especially in pediatric urology, are unknown. We sought to determine the health utility of various levels of severity of pediatric bladder dysfunction using an established and robust method known as the "Standard Gamble." METHODS: We first wrote three scenarios for describing pediatric patients with bladder dysfunction representing mild, moderate, or severe symptoms. We then used the Standard Gamble, a decision science technique to elicit an accurate health utility for each scenario. We gathered subject demographics and administered a brief test of three questions, after the standard gamble assessment, to determine numeracy (an individual's overall familiarity with numbers). We then adjusted final utilities to be weighted by the degree of subject numeracy (each correct answer provides a weight of 1). We subsequently performed linear regression to control for the effect of demographic variables and numeracy on health utility. RESULTS: We enrolled a total of 188 subjects, all of whom had at least one child under the age of 18. The median expected utility for mild, moderate, and severe bladder dysfunction was 0.97, 0.96, and 0.89, respectively. When adjusted for the numeracy of the subject, a modest positive shift in the expected utility occurred, with medians changing to 0.98, 0.98, and 0.92, respectively. This suggests that subjects with more understanding of probabilities were less concerned about the symptoms of bladder dysfunction. Most subjects were female (88%), black (50%), and had at least a college education (55%). 29% had annual family incomes greater than $100,000 per year, and 11% less than $25,000 per year. 13% answered 0 numeracy questions correctly, 35% answered 1 correctly, 37% answered 2 correctly, and 15% answered all three correctly. Linear regression showed that parents with higher numeracy (p = 0.0012), black race (p = 0.005), and income greater than $100,000 per year (p = 0.02) were less concerned with the symptoms of bladder dysfunction in their children. CONCLUSIONS: Using the Standard Gamble, we determined that most parents were bothered little by the symptoms of bladder dysfunction, even when it was severe. When subject numeracy was taken into account, only a small positive shift in utility occurred. Our sample was skewed towards educated parents with higher incomes. Numeracy, race, and income all were associated with shifts towards higher utilities, thus less concern for the symptoms of bladder dysfunction.


Back to 2017 Program