Development and Use of Health Outcome Descriptors: A Guideline Development Case Study

Abstract

OBJECTIVES: During health guideline development, panel members often have implicit, different definitions of health outcomes that can lead to variability in evidence synthesis and recommendations. McMaster GRADE Centre researchers developed a standardized description of health outcomes using the health marker state format. We aimed to determine which aspects of the development, content, and use of marker states were valuable to guideline developers. STUDY DESIGN & SETTING: We conducted a case study of marker state development with the European Commission Initiative on Breast Cancer (ECIBC) Guidelines Development Group (GDG). Eighteen GDG members provided written and interview feedback on the process. Using the health marker states, 2 health utility rating surveys were conducted near the beginning and end of development respectively. RESULTS: We developed 24 marker states for outcomes related to breast cancer screening and diagnosis. Feedback from GDG members revealed that marker states could be useful for developing recommendations and improving transparency of guideline methods. Comparison of the two health utility surveys showed a decrease in standard deviation in the second survey across 21 (88%) of the outcomes. CONCLUSIONS: Health marker states are a promising method, satisfying the pre-requisite of being feasible, acceptable, and with some initial result on reduction of variance of health utility scores.