This three-year study will consist of four phases: 1) refinement and testing of a multimedia preference assessment instrument; 2) assessing utilities for ADL dependencies from 1,200 elderly persons drawn from the Kaiser-Permanente Medical Care Program (KPMCP); 3) analyzing the relationships between utilities and respondents' characteristics; and 4) performing the cost-effectiveness analysis (CEA) and cost-benefit analysis of GEM. The investigators plan to assess utilities using a multimedia based computer software program called FLAIR. FLAIR consists of pictures, movies, voice recordings, and text to describe hypothetical health states to study participants. Following pilot testing, the investigators will obtain standard gamble and willingness-to-pay utilities for current health, dependency in each of seven ADLs, dependency in all seven ADLs, and dependency in each of six combinations of ADLs drawn from a factorial grid. Those health states encompass 98 percent of prevalent health states in the elderly. Utilities for the other two percent will be imputed using a regression model. Utilities will be incorporated with survival and direct medical costs into the CEA of GEM. In addition, the willingness-to-pay data will be used in a cost-benefit analysis. Effectiveness data for the economic analyses will come from one or more ongoing randomized trials of GEM.
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