Personalized medicine revolves around understanding the necessities of individuals pertaining to their health, treatment preferences, and quality of life. One of the methods to obtain this information is through utility functions, which are quantifiable signs of an individual’s preferences under uncertainty. Utility functions facilitate translation of qualitative judgments (for e.g., choosing between two treatments with different side effects) into a measurable guidance, often applicable in health economics, decision analysis, and planning of patient-centred care. Conventionally, extracting these personal utility functions needed face-to-face interviews or time-consuming surveys, restricting their generalizability and flexibility.(1, 2)
The evolving digital advancements are paving the way for preference elicitation, particularly through online platforms. Online Elicitation of Personal Utility Functions (OPUF) are the web-based tools or applications that help depict and measure individual preferences in real time. These tools usually encompass interactive assignments, visual aids, and adaptive questioning to make the process insightful for users, even without a prior experience with decision theory. OPUF platforms enable users to encounter hypothetical health scenarios, trade-offs, and outcomes in the comfort of their homes, making preference elicitation more user-friendly, scalable, and reactive to specific contexts.(2)
OPUF has several advantages. It minimizes the need for clinician time, reduces data collection costs, and facilitates the inclusion of various, geographically scattered populations. More prominently, it highlights the voice of the individuals in health technology assessment (HTA), economic assessments, and clinical decision-making. By depicting detailed and context-specific preferences, OPUF moves away from one-size-fits-all hypotheses and encourages more impartial and relevant health policy decisions. In resource-limited environments or for rare conditions, where general sweeping statements do not represent lived realities, OPUF provides a crucial link between individual values and population-level healthcare approaches.(2)
Early feasibility studies have shown promising results for OPUF in real-world applications. For instance, findings of a study valuing the EQ-HWB-S, a standard metric of health and wellbeing with nine dimensions, using OPUF in the UK reported that most participants completed the online tool in about 15 minutes, ranking the experience as easy, generating logically consistent and well-ordered utility measurements. Notably, the value sets generated using OPUF varied from those derived through conventional methods, showing that OPUF may summarize preferences in new and possibly more authentic ways.(3) Another large-scale study, incorporating OPUF into the broadly used EQ-5D-5L instrument with 874 UK participants, developed value sets both at the population level and for explicit subgroups and even individual respondents. Findings of this study showed high predictive accuracy of personal preferences and significant heterogeneity that was unexplainable with group-level characteristics, which further highlights OPUF’s potential to encourage accurately personalized health valuation.(4)
However, OPUF has several limitations. Concerns like digital literacy, understanding of abstract trade-offs, and the rational burden of making complex decisions online must be handled with careful design and pilot testing. It is also essential to prioritize confirming the validity, duplicability, and ethical use of these data. Moreover, data privacy issues, informed consent, and avoiding mishandling of preference data for biased or exclusive decision-making must be vigorously handled. Future developments in this domain include incorporating OPUF tools into electronic health records (EHRs), customizing them to different languages and cultures, and integrating artificial intelligence (AI) to enhance adaptivity and minimize respondent fatigue.(2, 3)
With the healthcare landscape shifting toward personalization and shared decision-making, OPUF is gaining prominence as a practical, novel tool to strengthen patient voices. By optimizing the reach of digital platforms and the strength of utility theory, OPUF can be instrumental in changing the understanding, depiction, and application of elements that are truly important to patients. Its role in prioritizing clinical and policy choices with individual values takes it beyond just the methodological innovation, making it an ethical requirement in modern healthcare.
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References
- Ubels J. The assessment of value in health economics: utility and capability. In: Kohlhammer VW, author; Schildmann J, Buch C, Zerth J, editors. Defining the Value of Medical Interventions: Normative and Empirical Challenges [Internet]. Stuttgart (DE): W. Kohlhammer GmbH; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK585087/
- Schneider PP, van Hout B, Heisen M, Brazier J, Devlin N. The Online Elicitation of Personal Utility Functions (OPUF) tool: a new method for valuing health states. Wellcome Open Res. 2022 Jan 14;7:14.
- Schneider P, Ludwig K, Marten O, et al. Using the OPUF approach to create a value set for the EQ-HWB-S: An exploratory feasibility study [version 1; peer review: 1 approved, 1 approved with reservations]. Wellcome Open Res. 2024; 9:359.
- Schneider P, Brazier J, Devlin N, van Hout B. PCR28 The OPUF Tool: A New Type of Online Survey for Creating Value Sets for the EQ-5D-5L on the Societal-, Group-, and Individual Person Level. Value Health 2022; 25(7):S546.