# Surgical prioritization based on decision model outcomes is not sensitive to differences between the health-related quality of life values estimates of physicians and citizens

## TL;DR

This study finds that differences in quality of life estimates between physicians and citizens have minimal impact on surgical prioritization decisions.

## Contribution

Shows that physician-derived HRQoL values are sufficient for decision models despite differences from citizen estimates.

## Key findings

- Citizens gave HRQoL values 0.07 points lower than physicians on average.
- Rankings of surgeries based on the two groups' values had a strong correlation of 0.96.
- Differences in values only caused adjacent switches in surgery rankings.

## Abstract

Decision models can be used to support allocation of scarce surgical resources. These models incorporate health-related quality of life (HRQoL) values that can be determined using physician panels. The predominant opinion is that one should use values obtained from citizens. We investigated whether physicians give different HRQoL values to citizens and evaluate whether such differences impact decision model outcomes.

A two-round Delphi study was conducted. Citizens estimated HRQoL of pre- and post-operative health states for ten surgeries using a visual analogue scale. These values were compared using Bland–Altman analysis with HRQoL values previously obtained from physicians. Impact on decision model outcomes was evaluated by calculating the correlation between the rankings of surgeries established using the physicians’ and the citizens’ values.

A total of 71 citizens estimated HRQoL. Citizens’ values on the VAS scale were − 0.07 points (95% CI − 0.12 to − 0.01) lower than the physicians’ values. The correlation between the rankings of surgeries based on citizens’ and physicians’ values was 0.96 (p < 0.001).

Physicians put higher values on health states than citizens. However, these differences only result in switches between adjacent entries in the ranking. It would seem that HRQoL values obtained from physicians are adequate to inform decision models during crises.

The online version contains supplementary material available at 10.1007/s11136-023-03544-5.