On the Assessment of Preferences for Health and Duration: Maximal Endurable Time and Better Than Dead Preferences (original) (raw)
Related papers
Value in Health, 2016
Background: Health states defined by multiattribute instruments such as the EuroQol five-dimensional questionnaire with five response levels (EQ-5D-5L) can be valued using time trade-off (TTO) or discrete choice experiment (DCE) methods. A key feature of the tasks is the order in which the health state dimensions are presented. Respondents may use various heuristics to complete the tasks, and therefore the order of the dimensions may impact on the importance assigned to particular states. Objective: To assess the impact of different EQ-5D-5L dimension orders on health state values. Methods: Preferences for EQ-5D-5L health states were elicited from a broadly representative sample of members of the UK general public. Respondents valued EQ-5D-5L health states using TTO and DCE methods across one of three dimension orderings via face-to-face computerassisted personal interviews. Differences in mean values and the size of the health dimension coefficients across the arms were compared using difference testing and regression analyses. Results: Descriptive analysis suggested some differences between the mean TTO health state values across the different dimension orderings, but these were not systematic. Regression analysis suggested that the magnitude of the dimension coefficients differs across the different dimension orderings (for both TTO and DCE), but there was no clear pattern. Conclusions: There is some evidence that the order in which the dimensions are presented impacts on the coefficients, which may impact on the health state values provided. The order of dimensions is a key consideration in the design of health state valuation studies.
PharmacoEconomics, 2016
Background: Discrete Choice Experiments with duration (DCETTO) can be used to estimate utility values for preference-based measures, such as the EQ-5D-5L. For self-completion, the health dimensions are presented in a standard order. However, for valuation, this may result in order effects. Thus, it is important to understand whether health state dimension ordering affects values. The aim of this study was to examine the importance of dimension ordering on DCE values using EQ-5D-5L. Methods: A choice experiment presenting two health profiles and a third immediate death option was developed. A three-arm study was used, with the same 120 choice sets presented online across each arm (n=360 per arm). Arm 1 presented the standard EQ-5D-5L dimension order, Arm 2 randomised order between respondents, and Arm 3 randomised within respondents. Conditional logit regression was used to assess model consistency, and scale parameter testing was used to assess model poolability. Results: There were minor inconsistencies across each arm, but the magnitude of the coefficients produced were generally consistent. Arm 3 produced the largest range of utility values (1 to-0.980). Scale parameter testing suggested that the models did not differ, and the data could be pooled. Follow up questions did not suggest variation in terms of difficulty. Conclusions: The results suggest that the level of randomisation used in DCE health state valuation studies does not significantly impact values, and dimension order may not be as important as other study design issues. The results support past valuation studies that use the standard order of dimensions.
Protocols for Time Tradeoff Valuations of Health States Worse than Dead: A Literature Review
Medical Decision Making, 2010
Background. The time tradeoff (TTO) method of preference elicitation allows respondents to value a state as worse than dead, generally either through the Torrance protocol or the Measurement and Valuation of Health (MVH) protocol. Both of these protocols have significant weaknesses: Valuations for states worse than dead (SWD) are elicited through procedures different from those for states better than dead (SBD), and negative values can be extremely negative. Purpose. To provide an account of the different TTO designs for SWD, to identify any alternatives to the MVH and Torrance approaches, and to consider the merits of the approaches identified. Methods. Medline was searched to identify all health state valuation studies employing TTO. The ways in which SWD were handled were recorded. Furthermore, to ensure that there are no unpublished but feasible TTO variants, the authors developed a theoretical framework for identifying all potential variants. Results. The search produced 593 hi...
Incorporating feelings related to the uncertainty about future health in utility measurement
Health Economics, 2008
The cost-effectiveness of health-care interventions is often evaluated using quality-adjusted life years (QALYs) as a measure of outcome. QALYs are valid representations of welfare only under the questionable assumption of additive independence of utility of health states across time periods. Therefore, some alternatives to QALYs have been proposed, among them healthy-year equivalents (HYEs) (Med. Decis. Making 1989; 9(2):142-149) and a semiseparable utility function (SSUF) (J. Health Econ. 2005; 24(1):33-54). This paper shows that HYEs using a single probability-equivalent standard gamble (SG) question measure the same health construct as the SSUF, which uses a series of probability-equivalent SG questions. The underlying assumption is that final health states are independent of initial health states. In contrast to the SSUF, however, HYEs are not bound by this assumption and also avoid propagating bias in the measurement of SG utilities from one question to the next. This paper also shows that both approaches can incorporate feelings related to the uncertainty about future health and capture them by using certainty equivalent questions.
A new method for valuing health: directly eliciting personal utility functions
The European Journal of Health Economics, 2018
Background Standard methods for eliciting the preference data upon which 'value sets' are based generally have in common an aim to 'uncover' people's preferences by asking them to evaluate a subset of health states, then using their responses to infer their preferences over all dimensions and levels. An alternative approach is to ask people directly about the relative importance to them of the dimensions, levels and interactions between them. This paper describes a new stated preference approach for directly eliciting personal utility functions (PUFs), and reports a pilot study to test its feasibility for valuing the EQ-5D. Methods A questionnaire was developed, designed to directly elicit PUFs from general public respondents via computerassisted personal interviews, with a focus on helping respondents to reflect and deliberate on their preferences. The questionnaire was piloted in England. Results Seventy-six interviews were conducted in December 2015. Overall, pain/discomfort and mobility were found to be the most important of the EQ-5D dimensions. The ratings for intermediate improvements in each dimension show heterogeneity, both within and between respondents. Almost a quarter of respondents indicated that no EQ-5D health states are worse than dead. Discussion The PUF approach appears to be feasible, and has the potential to yield meaningful, well-informed preference data from respondents that can be aggregated to yield a value set for the EQ-5D. A deliberative approach to health state valuation also has the potential to complement and develop existing valuation methods. Further refinement of some elements of the approach is required.
People in states worse than dead according to the EQ-5D UK value set: would they rather be dead?
Quality of Life Research, 2018
Purpose Quality-adjusted life years (QALYs) measure health by combining length and quality of life. QALYs constitute the effect side of incremental cost-effectiveness ratios, describing the results of health economic evaluations. The objectives of this study were to (1) investigate the prevalence of states worse than dead (SWD) when using the EuroQol-5D UK value set, and (2) to study to what extent SWDs are reasonable with a starting point in experience-based valuations of health states. Methods Data from a Swedish cross-sectional population survey were used. The survey was directed to 10,000 persons 65 years and older and its primary aim was to investigate the prevalence and consequences of chronic pain. The survey included questions reflecting life situation and well-being. Some of these were used in order to characterise people in SWD. Results SWD were found in 1.8% of the 6611 respondents. The prevalence of SWD increased with advancing age and was more common among women than men. The control questions used indicated that most of the persons being in SWD according to the EQ-5D UK value set most probably would not judge themselves to be in a SWD. Conclusions Though negative QALY-weights are not very common, they constitute a non-negligible part of health states in a Swedish population 65 years and older. Prevalence of SWD is higher among women than men and increases with age. From responses to other questions on well-being and life situation, there is reason to doubt the reasonableness of experience-based negative QALY-weights in many cases.
Sensitivity and perspective in the valuation of health status: whose values count?
Health Economics, 2000
The literature was studied on the existence of differences in valuation for hypothetical and actual health states between patients and other-rater groups. It was found that nine different study designs have been used to study this question and two of these designs were applied in a study involving dialysis patients and other rater groups. In the first study, both dialysis patients and students had to value hypothetical health states with Standard Gamble (SG) and Time Trade Off (TTO). Patients assigned higher values to hypothetical health states than students did. In the second study, dialysis patients who were being treated with four different dialysis modalities were asked to value their own health state with SG, TTO and a visual analogue scale (EQ VAS ), and to describe their health state on the EQ-5D profile . Several EQ-5D index values (health index values derived from general population samples) were calculated for the four dialysis treatment groups, based on the EQ-5D profile . These health indexes could discriminate between treatment groups, according to clinical impressions. Treatment groups could not be differentiated based on patients' valuations of own health state. The results suggest that general population samples, using EQ-5D index values, may be more able to discriminate between patient groups than the patients themselves are. The implications of this finding for valuation research and policy-making are discussed. Copyright