Patient Experiences with Clostridioides difficile Infection and Its Treatment: A Systematic Literature Review.

INTRODUCTION: Clostridioides difficile infection (CDI) is a globally recognized cause of morbidity and mortality with devastating effects on health-related quality of life (HRQoL). The objective of this study was to conduct the first systematic literature review (SLR) to assess the humanistic burden of CDI on patient experiences, including HRQoL and related constructs, and attitudes towards treatment alternatives. METHODS: An SLR was conducted to identify peer-reviewed articles that assessed CDI, including recurrent CDI (rCDI), and patient-reported outcomes or HRQoL. PubMed, Embase, and the Cochrane Collaboration abstracting services were used to conduct literature searches from 2010 to 2021 in the English language. This SLR was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. RESULTS: Of 511 identified articles, 21 met study inclusion criteria. The SLR showed CDI has a devastating impact on patients' overall HRQoL that continues well beyond infection clearance. The impact of CDI on physical, emotional, social, and professional well-being rivaled abdominal symptoms of uncontrollable diarrhea, being worse for patients with rCDI. Patients with CDI feel isolated, depressed, lonely, and continue to be frightened of recurrences as well as being contagious to others. Most believe that they will never be free of CDI. CONCLUSION: CDI and rCDI are debilitating conditions affecting physical, psychological, social, and professional functioning of patients' HRQoL, even long after the event has occurred. The results of this SLR suggest that CDI is a devastating condition in need of better prevention strategies, improved psychological support, and treatments that address the microbiome disruption to break the cycle of recurrence. Additional safe and effective therapies are needed to address this unmet medical need.

Clostridioides difficile infection is a gut bacterial infection that can happen after a person has taken antibiotics to treat another infection. C. difficile infection can lead to other medical problems and death. This review of the literature aimed to understand how C. difficile infection (first, previous, and repeat occurrences), the severe diarrhea it causes, and available treatments (both old and new) for C. difficile infection can impact a person's quality of life, daily self-care activities, and attitudes toward treatment. Results from this review of 21 studies showed that C. difficile infection has a negative impact on the quality of life of patients, affecting their physical, mental, and social health. C. difficile infection also disrupted the professional lives of patients and their ability to perform work activities. This negative effect continued over time, long after the infection had cleared because patients feared it would come back again. Treating C. difficile infection improved quality of life. Findings suggest that C. difficile infection is a devastating condition that needs better prevention strategies, improved psychological support, and treatments that stop the cycle of repeated gut infections by restoring good gut flora.

Doctor of pharmacy student preferences for computer-based vs. paper-and-pencil testing in a, social and administrative pharmacy course.

INTRODUCTION: The use of online learning and subsequent online testing has expanded rapidly in pharmacy programs across the United States. Numerous published studies have compared online learning with traditional methods in pharmacy. However, no such studies have been published in pharmacy. This study's objective is to compare first-professional year student preferences for computer-based vs. traditional paper-and-pencil testing for a required social and administrative pharmacy class. METHODS: All students enrolled in the class were invited to complete one brief survey at the end of the semester to determine their testing preference. RESULTS: Of the 138 first-professional year students completing the survey, 79% (109 of 138) preferred computer-based testing, 9% had no preference, 6% (8 of 138) preferred paper-and-pencil testing, and the remainder (8 of 138) stated it depended on what was being tested. Ninety-one percent of students did not perceive the testing method to impact their grades. Students preferred computer-based testing over traditional paper-and-pencil as a convenient testing method (mean 4.73 vs. 3.4, P < .001), providing immediate feedback (mean 4.87 vs. 1.91, P < .001), and as a more effective testing method (mean 4.57 vs. 3.96, P < .001). CONCLUSIONS: First-professional year students preferred computer-based over traditional paper-and-pencil testing for a social and administrative science class, with the method of testing not perceived to impact grade. This finding is timely, given the recent required transitioning of all pharmacy classes and subsequent testing to an online format due to the coronavirus disease of 2019 pandemic.

Comparing the validity of the payment card and structured haggling willingness to pay methods: The case of a diabetes prevention program in rural Kenya.

BACKGROUND: The objective of this study was to compare the theoretical validity of two willingness-to-pay (WTP) methods, the commonly used payment card (PC) and the recently developed structured haggling (SH), for estimating the potential benefits of a diabetes prevention program in rural Kenya. METHODS: A convenience sample of adult residents from a rural county in Kenya (Kiambu), with no history of diabetes, was randomly assigned to one of two WTP methods, PC or SH, using structured face-to-face interviews from December 2011 to February 2012. RESULTS: A total of 376 respondents completed the interviews using PC (n = 185) or SH (n = 191). More than 95% of respondents were willing to pay something for program access. The study showed that both methods were feasible in rural Kenya. SH resulted in a higher annual mean WTP than PC, Ksh504.05 (US$7.25) versus Ksh619.95 (US$5.90), respectively (p < 0.01). Based on theory, it was hypothesized that certain predisposing factors would result in greater WTP. Greater socio-economic status (measured using income proxies) resulted in greater unconditional WTP for both the PC and SH groups (t-tests and bivariate correlations) and conditional WTP (GLM models). GLM for PC showed being male, employed and having distant relatives with diabetes were significant predictors for WTP, while for SH being educated, employed and owning a vehicle were significant predictors. CONCLUSION: Both PC and SH showed theoretical validity in rural Kenya. However, the use of SH over PC in rural Kenya may be the better choice given that SH more closely mirrors marketplace transactions in this setting and the use of SH resulted in more significant variables in the GLM models.

A welfare economic approach to measure outcomes in stuttering: comparing willingness to pay and quality adjusted life years.

PURPOSE: The purpose of this study was to compare two welfare outcome measures, willingness to pay (WTP) and quality adjusted life years (QALYs) gained, to measure outcomes in stuttering. METHOD: Seventy-eight adult participants (74 nonstuttering and 4 persons with stuttering) completed one face-to-face structured interview regarding how much they would be willing to pay to alleviate severe stuttering in three interventions of varying impact. These data were compared with QALYs gained as calculated from time trade off (TTO) and standard gamble (SG) data. RESULTS: Mean (median) WTP bids ranged from US $16,875 (8000), for an intervention resulting in improvement from severe stuttering to mild stuttering, to US $41,844 (10,000) for an intervention resulting in a cure of severe stuttering. These data were consistent with mean changes in QALYs for the same stuttering interventions ranging from 2.19 (using SG) to 18.42 (using TTO). CONCLUSIONS: This study presents the first published WTP and QALY data for stuttering. Results were consistent with previous cost-of-illness data for stuttering. Both WTP and QALY measures were able to quantify the reduction in quality of life that occurs in stuttering, and both can be used to compare the gains that might be achieved by different interventions. It is widely believed that stuttering can cause reduced quality of life for some speakers; the introduction into this field of standardized metrics for measuring quality of life is a necessary step for transparently weighing the costs and consequences of stuttering interventions in economic analyses. EDUCATIONAL OBJECTIVES: The reader will be able to (a) describe the underlying theoretical foundations for willingness to pay and quality adjusted life years, (b) describe the application of willingness to pay and quality adjusted life years for use in economic analyses, (c) compare and contrast the value of willingness to pay and quality adjusted life years in measuring the impact of stuttering treatment on quality of life, (d) interpret quality adjusted life years, and (e) interpret willingness to pay data.

Assessment of respondent acceptability for preference measures in stuttering.

PURPOSE: To assess the feasibility of using one or more of four standard economic preference measures to assess health-related quality of life in stuttering, by assessing respondents' views of the acceptability of those measures. METHOD AND RESULTS: A graphic positioning scale approach was used with 80 adults to assess four variables previously defined as reflecting the construct of respondent acceptability (difficulty of decision making, clarity of text, reasonableness for decision making, and comfort in decision making) for four types of preference measurement approaches (rating scale, standard gamble, time trade-off, and willingness to pay). A multivariate repeated measures analysis of variance (p<.001) and follow-up univariate repeated measures analyses of variance (all p<.01) were all significant, indicating that respondents perceived differences among the preference measurement methods on all four acceptability variables. CONCLUSION: The rating scale was perceived as the easiest, clearest, most reasonable, and most comfortable tool, but it is not a measure of utility (an economic term for desirability or worth). If utility is the objective, such as for cost-utility analyses in stuttering, then the present results suggest the use of standard gamble (rather than time trade-off). These results also support the use of willingness to pay assessments for cost-benefit analyses in stuttering. These findings supplement results previously obtained for other chronic conditions. LEARNING OUTCOMES: The reader will be able to: (1) describe how four standard economic preference measures [rating scale (RS), time trade-off (TTO), standard gamble (SG), and willingness to pay (WTP)] can be used in economic analyses; (2) describe how RS, TTO, SG and WTP can be measured; and (3) describe how respondents perceive the use of RS, TTO, SG and WTP in measuring changes in stuttering.

A qualitative study of herbal medicine use in the Ukraine: implications for US pharmacy practice.

INTRODUCTION: Half of nearly all new immigrants in the United States come from only 10 countries, including the Ukraine. Immigrants bring facets of their culture to their new country; therefore, it is important for health care providers to have an appreciation and understanding of cultural differences in regard to the use of herbal medicine. OBJECTIVES: To determine health care provider and patient preferences for herbal versus synthetic medications, health care provider didactic training in pharmacognosy and trends in herbal medication use in the Ukraine. METHODS: Ten health care providers, pharmacists and physicians, were interviewed to determine their views on herbal medicine use in Ukraine using semistructured in-depth face-to-face interviews. RESULTS: Ukrainian practitioners and patients viewed herbal medicines as safer than synthetic drugs, appropriate and preferable for use in chronic and preventative programs. Synthetic drugs were viewed as more desirable for use in the acute setting. Preference for synthetic versus herbal medication was not price driven. CONCLUSIONS: The inclusion of pharmacognosy training in the US pharmacy curricula is recommended to facilitate US health care professional's ability to provide pharmaceutical care both to new US immigrants and to the increasing number of US citizens utilizing herbal medications.

U.S. publication trends in social and administrative pharmacy: implications for promotion and tenure.

BACKGROUND: There is no consensus on the preferred approach to assess journal quality. Procedures previously used include journal acceptance or rejection policies, impact factors, number of subscribers, citation counts, whether the articles were refereed or not, and journals cited in books within the discipline. This study built on the work of previous authors by using a novel approach to assess journal quality in social and administrative pharmacy (SAdP). OBJECTIVES: To determine U.S. SAdP faculty perceptions of prestigious journals for their research, SAdP faculty perceptions of prestigious journals by their promotion and tenure (P&T) committees, and current research trends in SAdP. METHODS: A census of U.S. colleges and schools of pharmacy was conducted using an e-mailed survey and an open-ended approach requiring respondents to list their preferred journals. RESULTS: Seventy-nine SAdP faculty reported that the 5 most prestigious journals were JAMA, New England Journal of Medicine, Health Affairs, Health Services Research, and Medical Care. These journals were selected because respondents wished to seek broad readership. CONCLUSIONS: Results of this study can be used as a guide by U.S. SAdP faculty and P&T committees to assess the quality of publications by pharmacy administration faculty with the caveat being that pharmacy versus nonpharmacy journals will be chosen based on the fit of the article with the audience.

Pharmacy patronage: identifying key factors in the decision making process using the determinant attribute approach.

OBJECTIVE: To use the determinant attribute approach, a research method commonly used in marketing to identify the wants of various consumer groups, to evaluate consumer pharmacy choice when having a prescription order filled in different pharmacy settings. DESIGN: Cross sectional. SETTING: Community independent, grocery store, community chain, and discount store pharmacies in Georgia between April 2005 and April 2006. PARTICIPANTS: Convenience sample of adult pharmacy consumers (n = 175). INTERVENTION: Survey measuring consumer preferences on 26 attributes encompassing general pharmacy site features (16 items), pharmacist characteristics (5 items), and pharmacy staff characteristics (5 items). MAIN OUTCOME MEASURE: 26 potential determinant attributes for pharmacy selection. RESULTS: 175 consumers were surveyed at community independent (n = 81), grocery store (n = 44), community chain (n = 27), or discount store (n = 23) pharmacy settings. The attributes of pharmacists and staff at all four pharmacy settings were shown to affect pharmacy patronage motives, although consumers frequenting non-community independent pharmacies were also motivated by secondary convenience factors, e.g., hours of operation, and prescription coverage. CONCLUSION: Most consumers do not perceive pharmacies as merely prescription-distribution centers that vary only by convenience. Prescriptions are not just another economic good. Pharmacy personnel influence pharmacy selection; therefore, optimal staff selection and training is likely the greatest asset and most important investment for ensuring pharmacy success.

Psychometric evaluation of condition-specific instruments used to assess health-related quality of life, attitudes, and related constructs in stuttering.

PURPOSE: This study assessed the psychometric properties of instruments used to measure constructs similar to stuttering-specific health-related quality of life. In the stuttering literature, most such instruments were originally intended to measure speakers' attitudes about, or reactions to, their stuttering. METHOD: Seventeen instruments were identified through a comprehensive literature search. Based on specific criteria from previous publications, 10 were selected for complete review and evaluated using 15 measurement standards related to conceptual model, reliability, validity, responsiveness, interpretability (norms), burden (respondent and administrative), depth, and versatility. RESULTS: None of the available instruments met more than 8 of the 15 measurement standards assessed. CONCLUSIONS: Available instruments do not satisfy psychometric criteria for use in individual or group-level decision making, either as measures of their originally intended constructs or as measures of health-related quality of life. Problems with the conceptual model, reliability, validity, and responsiveness of available instruments, as well as the lack of comprehensive normative data, combine to suggest the need for development and validation of a stuttering-specific health-related quality of life measure.

Patient-reported outcomes in stuttering treatment: conceptual framework.

Evaluation of: Yaruss JS, Quesal RW. Overall Assessment of the Speaker's Experience of Stuttering (OASES): documenting multiple outcomes in stuttering treatment. J. Fluency Disord. 31(2), 90-115 (2006) [1] . These authors presented the first complete instrument intended to measure the impact of stuttering in adults who stutter (Overall Assessment of the Speaker's Experience of Stuttering; [OASES]). OASES is a 100-item self-report metric with four sections: general information, reactions to stuttering, communication in daily situations and quality of life. Its conceptual framework includes historic views of the influence of emotional and cognitive variables on stuttering; the WHO's International Classification of Impairments, Disabilities and Handicaps (ICIDH); and the WHO's International Classification of Functioning, Disability and Health (ICF). However, both this conceptual framework and the psychometric data presented to support the OASES are problematic in ways that clinicians and researchers in areas well-beyond stuttering may find informative as they consider their own applications.

Stuttering treatment research 1970-2005: II. Systematic review incorporating trial quality assessment of pharmacological approaches.

PURPOSE: To complete a systematic review, incorporating trial quality assessment, of published research about pharmacological treatments for stuttering. Goals included the identification of treatment recommendations and research needs based on the available high-quality evidence. METHOD: Multiple readers reviewed 31 articles published between 1970 and 2005, using a written data extraction instrument developed as a synthesis of existing standards and recommendations. Articles were then assessed using 5 methodological criteria and 4 outcomes criteria, also developed from previously published recommendations. RESULTS: None of the 31 articles met more than 3 of the 5 methodological criteria (M = 1.74). Four articles provided data to support a claim of short-term improvement in social, emotional, or cognitive variables. One article provided data to show that stuttering frequency was reduced to less than 5%, and 4 additional articles provided data to show that stuttering may have been reduced by at least half. Among the articles that met the trial quality inclusion criterion for the second stage of this review, none provided uncomplicated positive reports. CONCLUSIONS: None of the pharmacological agents tested for stuttering have been shown in methodologically sound reports to improve stuttering frequency to below 5%, to reduce stuttering by at least half, or to improve relevant social, emotional, or cognitive variables. These findings raise questions about the logic supporting the continued use of current pharmacological agents for stuttering.

Using preference-based measures to assess quality of life in stuttering.

PURPOSE: The purpose of this study was to determine whether standard pharmaco-economic preference methods can be used to assess perceived quality of life in stuttering. METHOD: Seventy-five nonstuttering adults completed a standardized face-to-face interview that included a rating scale, standard gamble, and time trade-off preference measures for 4 health states (your health and mild, moderate, and severe stuttering) in the context of 2 anchor states (perfect health and death). RESULTS: Results showed mean utility values between .443 for severe stuttering estimated using the rating scale technique and .982 for respondents' own current health estimated using a standard gamble technique. A two-way repeated measures analysis of variance and post hoc tests showed significant effects for method, health state, and the interaction. CONCLUSIONS: These results confirm that utility estimates can differentiate between stuttering severity levels and that utility scores for stuttering conform to the known properties of data obtained using these standard measurement techniques. These techniques, therefore, can and should be further investigated as potential contributors to complete measurement protocols for the study and treatment of stuttering.

Potentially inappropriate drug use and health-related quality of life in the elderly.

STUDY OBJECTIVE: To investigate the relationship between two widely used, generic health-related quality of life (HRQOL) measures, Short Form-12 (SF-12) and EuroQol's EQ-5D, and potentially inappropriate drug use in an elderly cohort. DESIGN: Longitudinal retrospective cohort study. DATA SOURCE: Medical Expenditure Panel Survey, panel 5. PARTICIPANTS: Respondents aged 65 years or older. MEASUREMENTS AND MAIN RESULTS: Participants with potentially inappropriate drug use were identified by using National Drug Codes based on the Beers updated criteria. The dependent variable, HRQOL, was measured by using self-reported scores on the SF-12 (physical component summary, mental component summary, and global rating of health) and the EQ-5D (index and visual analog scale). The HRQOL data were regressed onto scores for potentially inappropriate drug, age, sex, number of prescriptions, race, comorbidity, and previous HRQOL. Regression analysis revealed statistically significant models for all five HRQOL equations (adjusted R2=26.50-53.83%, p<0.0001). However, potentially inappropriate drug use was not a significant predictor of HRQOL in any of the models tested. Previous HRQOL, as measured by using the SF-12 (global, physical component summary, and mental component summary) and the EQ-5D (index and visual analog scale), was a significant predictor of HRQOL; number of prescriptions was also a significant predictor of HRQOL, as measured by using the SF-12 (global and physical component summary) and the EQ-5D (index and visual analog scale). CONCLUSION: The results supported others showing that a significant proportion of the elderly receive care that is potentially harmful and not supported by evidence-based practice. Use of a disease-specific HRQOL scale may be more responsive to measuring the impact of potentially inappropriate drugs on patients' HRQOL.

Psychometric evaluation of disease specific quality of life instruments in voice disorders.

The objective of this study was to compare the psychometric properties of voice disordered quality of life (VQOL) instruments. Nine VQOL instruments were identified through a comprehensive literature search. Based on specific criteria, four were selected for comprehensive review: Voice Handicap Index (VHI), Voice Activity and Participation Profile (VAPP), Voice-Related Quality of Life (V-RQOL) and Voice Outcome Survey (VOS). Selected instruments were evaluated based on 11 measurement standards related to item information, versatility, practicality, breadth and depth of health measure, reliability, validity, and responsiveness. VHI and V-RQOL each met 7 of 11 criteria, with VHI showing additional preferable item information, practicality, and reliability over V-RQOL and V-RQOL showing preferable responsiveness properties over VHI. These study results do not support the Social Security Administration's recent conclusion that the VHI meets reliability and validity standards for individual decision making. Nevertheless, the present results do support the use of VHI total scores for clinical use with individual patients, and the use of V-RQOL total scores or individual dimension scores for use with groups of patients.

Quality-adjusted life years was a poor predictor of women's willingness to pay in acute and chronic conditions: results of a survey.

OBJECTIVE: We investigated the relationship between quality-adjusted life years (QALYs) and willingness to pay (WTP) in acute and chronic conditions. STUDY DESIGN AND SETTING: Face-to-face interviews were used to collect data in a convenience sample of women. Participants completed one interview evaluating preferences for an acute condition, post-chemotherapy nausea and vomiting (PCNV), and the other interview for a chronic condition (breast cancer). Preferences were elicited for QALYs using visual analogue scale (VAS), and standard gamble in addition to WTP. Because QALYs and WTP are purportedly based on the same underlying theoretical foundations, WTP was regressed onto change in QALYs, age, income, and health status. RESULTS: Regression analysis reported statistically significant models for all breast cancer (P < .001) and PCNV (P < .05) conditions tested. However, QALY was not a significant predictor of WTP. CONCLUSION: The results of this study indicate QALYs was a poor predictor of WTP for the conditions tested. Linear combinations of change in QALYs, age, income, and health status were a better predictor of WTP for chronic than acute conditions. This can be attributed to violations of underlying assumptions in measurement of QALYs with acute conditions and to problems with the use of WTP with chronic conditions.

Adherence, asthma control, generic and disease-specific quality-of-life instruments in asthma.

Prior studies have investigated the association between generic health-related quality of life and medication adherence. The objective of this study was to assess the association between medication adherence and health-related quality of life using both a disease-specific and generic metric in a community setting. Overall, the authors' study findings show no association between adherence and health-related quality of life, supporting the results by Cote and colleagues that factors other than medication adherence are important in explaining health-related quality of life. Furthermore, adherence was not significantly associated with asthma severity, although the strong association between asthma control and health-related quality of life, and asthma control and adherence indicates that asthma control is an important vital sign.

Effect of including (versus excluding) fates worse than death on utility measurement.

OBJECTIVES: Most studies typically measure health preferences excluding health states perceived as worse than death. The objective of this study is to test the impact of including (versus excluding) health states perceived to be worse than death on utility measurement using standard gamble (SG) and visual analogue scale (VAS) methods. METHODS: By means of a cross-sectional descriptive study design, women were asked to rate the utility of three hypothetical breast cancer health states: cure, treatment, and recurrence (n=119). Preference weights were estimated, allowing for negative utilities with death (perfect health) scaled at zero (1.0). RESULTS: Unpaired t-test analysis showed significantly greater change in SG and VAS weights for individuals perceiving cancer recurrence as worse than death than those perceiving death as least desirable state. Excluding negative utilities from the study resulted in significantly smaller changes in utility. Study results show that preference elicitation methods can be successfully adapted to acquire negative utilities. CONCLUSIONS: Changes in utility were greater when negative preferences were permitted. Addressing negative preference scores could significantly affect quality adjusted life year estimates in economic analyses.

Assessment of respondent acceptability of preference measures: discriminatory power of graphic positioning scale versus traditional scaling measures.

OBJECTIVE: The objective of this study was to compare discriminatory power of two different measures-graphic positioning scale (GPS) versus traditional scale (TS)-in assessing respondent acceptability of three preference measures: visual analog scale (VAS), standard gamble (SG), and willingness to pay (WTP). METHODS: Two face-to-face interviews were conducted at least 1 week apart in a convenience sample of women aged 22 to 50 years with no history of breast cancer or cancer requiring chemotherapy. Study participation required completion of two surveys: one evaluating health preferences for an acute condition (chemotherapy-induced nausea and vomiting) and one evaluating a chronic condition (breast cancer). Data were collected from March 2000 to June 2000 at Ohio State University. Respondents were randomized to either GPS or TS surveys. Data analysis was a two-step process. First, a four-way multivariate repeated-measures analysis of variance (MANOVA) was conducted to assess respondent acceptability of three-preference metrics-VAS, SG, and WTP-in health-care decision making. Each of the four dependent variables, difficulty, clarity, reasonableness, and comfort in use in decision making, was measured on 9-point Likert scale. Second, a mixed design univariate analysis of variance (ANOVA) was performed for each dependent variable to optimize MANOVA analysis. Univariate ANOVAs, 2 x (2 x 3), were composed of three independent variables: assessment (GPS/TS), condition (acute and chronic), and preferences (VAS, SG, WTP). RESULTS: Of 126 respondents, 119 were usable and complete. MANOVA results showed (P <.05) for two main effects, condition (F4,114 = 6.375) and preferences (F8,110 = 9.290), and two significant interactions, condition x assessment (F4,114 = 3.421) and condition x preferences (F8,110 = 2.087). CONCLUSION: GPS has higher discriminatory power than TS in assessing respondent attitudes toward health preference measures. Results showed that respondents had more difficulty and less comfort when making decisions for chronic than for acute conditions. Results also show that respondents regard WTP as a more reasonable decision-making tool when assessing acute interventions in preference to SG and vice versa for chronic conditions. Of VAS, SG, and WTP methods, VAS was perceived as being the easiest to understand. These results can be explained by direct versus indirect comparisons made with GPS and TS methods, respectively.

Are health states 'timeless'? A case study of an acute condition: post-chemotherapy nausea and vomiting.

RATIONALE, AIMS AND OBJECTIVES: The objective was to test whether individuals' responses to standard gamble (SG) and visual analogue scale (VAS) questions do not depend on the time horizon of the health scenario presented. METHODS: Face-to-face interviews were conducted in a convenience sample of 18 women aged 22-50 years with no history of breast cancer or cancer requiring chemotherapy. Data were collected from March 2000 to June 2000 at a university in the Midwest of the United States of America. Preference weights were estimated using SG top-down titration method and VAS scaled from zero (death) to one (perfect health). Subjects were asked to rate their preferences if faced with two scenarios: post-chemotherapy nausea and vomiting (PCNV) occurring for 3 days (scenario 1), and PCNV lasting for the rest of their lives (scenario 2). Three PCNV health states of varying severity were tested: complete alleviation, partial alleviation, and no alleviation. RESULTS: Paired-t-test analysis showed statistically significantly lower preference weights (P < 0.05) when the health state was for the rest of the respondent's life vs. 3 days. Mean SG weights for scenario 1 vs. scenario 2 were: 0.968 vs. 0.927 (complete alleviation), 0.942 vs. 0.810 (partial alleviation) and 0.866 vs. 0.644 (no alleviation). Mean VAS weights for scenario 1 vs. scenario 2 were: 0.741 vs. 0.676 (complete alleviation), 0.490 vs. 0.307 (partial alleviation) and 0.276 vs. 0.136 (no alleviation). DISCUSSION AND CONCLUSIONS: For the majority of respondents the utility independence assumption for SG and VAS did not hold. Similar to Bala et al., the results of this study indicated that preference weights as measured by SG and VAS techniques were not 'timeless'. Regardless of the preference measure used, both SG and VAS yielded higher scores when PCNV lasted for a shorter period of time.