Importance of each benefit and harm

Consider how important each advantage and disadvantage is when weighing the pros and cons of a health action.

A decision about whether to use a health action depends on how important each benefit and harm is to the person using the health action. The importance of the benefits and harms may be different for different people.

Explanation

People making health choices should consider all the outcomes  that are important to the person or people affected by the health action.

How helpful or harmful a health action is depends on how important the advantages and disadvantages are. Different people may value the benefits and harms (outcomes) differently. Sometimes different people will make different choices because of this. For example, taking a medicine may reduce earache (a benefit), but may also cause harms, like diarrhoea. Some people might think that an earache is a more important problem for them than diarrhoea and therefore may be more likely to decide to use the medicine. Others may think that diarrhoea is a more important problem for them, so they may be more likely to decide not to use the medicine.

In addition, people usually place more value on outcomes that happen soon than on outcomes that happen years into the future. In other words, the further into the future an outcome (for example, reducing the chance of heart disease or cancer after many years) the more people tend to “discount” its value or importance. The balance between the benefits and harms of health actions may also depend on how much costs and events in the future are discounted. How long a health problem lasts affects how important it is to some people, as well as how severe it is. Because of differences in both the severity and duration of different outcomes of a health action, it can be misleading when researchers group together outcomes, such as “cardiovascular events”, which can include heart attacks, strokes, deaths, and other outcomes (with different degrees of severity, duration, and occurrence) that different people may value very differently.

When decisions are made for a group of people rather than for individuals, it is important to consider how much all the people affected by the decision value the benefits and harms and whether there is important variability in how much people value the benefits and harms.

Example

Researchers have found that taking low-dose aspirin every day reduces the likelihood of deaths, heart attacks and strokes but slightly increases the likelihood of serious bleeding in the gut. In someone 60 years old with a low likelihood of having a heart attack or stroke (a low baseline risk), the main advantage is a reduced chance of having a heart attack or stroke. The main disadvantage is an increased chance of having serious bleeding in the gut. Although aspirin costs very little, for someone with very little money, this might be another important disadvantage. There is minimal inconvenience – taking a pill every day for 10 years. However, for some people this might be enough of a bother to be another disadvantage.

Someone for whom avoiding having a heart attack is more important than having serious bleeding in their gut and who is not concerned about the cost or the bother, might choose to take aspirin. On the other hand, someone for whom avoiding serious bleeding in the gut is more important than avoiding a heart attack might choose not to take aspirin, especially if they were concerned about the cost or the bother.

Remember: Consider how important each advantage and disadvantage is when choosing a health action.

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