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J Pediatr Urol. 2014 Dec;10(6):1026-31. doi: 10.1016/j.jpurol.2014.02.014. Epub 2014 Apr 4.

Estimating utility values for vesicoureteral reflux in the general public using an online tool.

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Division of Urologic Surgery, Duke University Medical Center, DUMC 3831, Durham, NC 27710, USA.
Research on Research Group, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Department of Urology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Department of Urology, Children's Hospital of Boston, Boston, MA, USA.
Division of Urologic Surgery, Duke University Medical Center, DUMC 3831, Durham, NC 27710, USA. Electronic address:



Cost-utility analyses are useful to study conditions without a widely accepted treatment algorithm; in pediatric urology, one such condition is vesicoureteral reflux (VUR). A necessary component of cost-utility analyses is to accurately calculate the "utility", a numerical surrogate of quality of life, for various health states. Our aims were to determine utility values for representative VUR health states and to verify the feasibility of a novel online platform for utility elicitation in order to reduce the time and expense of such analyses.


A cross-sectional survey of American adults was conducted using the time-trade-off (TTO) method. Respondents were recruited from an online work interface, Amazon's Mechanical Turk (MTurk). Four annualized VUR health states were assessed: VUR treated with/without continuous antibiotic prophylaxis (CAP) and with/without associated febrile urinary tract infection (UTI). A 6-week post-operative scenario following open ureteroneocystostomy was also assessed.


We received 278 survey responses (70% response rate). The respondents were largely between the ages of 25 and 44 (59%), female (60%), and Caucasian (76%). Thirty-seven percent had a college degree, and 44% were parents. Compared with a perfect health state of 1.0, we found mean utilities of 0.87 for VUR, regardless of whether CAP was used or whether UTI was present (p=0.9). The immediate post-operative period following ureteroneocystostomy garnered an annualized utility of 0.94.


Our data suggest that MTurk-based utility assessment is feasible, and that subjects view the VUR health state as only slightly inferior to perfect health. This includes VUR health states incorporating CAP and febrile UTI.


Pediatric; Urology; Utility theory; Vesicoureteral reflux

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