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Rodríguez-Míguez E, Sampayo A. Comparison of Caregiver and General Population Preferences for Dependency-Related Health States. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024:10.1007/s40258-024-00908-x. [PMID: 39256323 DOI: 10.1007/s40258-024-00908-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVE We assess whether the preferences regarding dependency-related health states as stated by informal caregivers are aligned with those expressed by the general population. METHODS The preferences of a sample of 139 Spanish informal caregivers of dependent patients are compared with those obtained via a sample of 312 persons, also from the Spanish general population. We assess 24 dependency states extracted from the DEP-6D using the time trade-off method. Descriptive statistics and regression methods are used to explore differences between the two samples. RESULTS Mean difference tests establish that, for all but one of the 24 states, there are no significant differences between the samples. The estimated mean values ranged from - 0.64 to 0.60 for the caregiver sample and from - 0.60 to 0.65 for the general population sample, with a correlation of 0.96. On average, the classification of states as better or worse than dead matched in both samples (except for one state). Regression models also show that sample type does not have a significant average impact. After we introduce interaction effects, only the most severe level of two dimensions, cognitive problems and housework, result in significant differences-with the caregiver sample reporting higher values for the former, and lower values for the latter. CONCLUSION Caregivers and the general population exhibit quite similar preferences concerning dependency-related health states. This suggests that the results of cost-utility analyses, and the resource allocation decisions based on them, would likewise not be significantly affected by the preferences used to generate the weighting algorithm.
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Affiliation(s)
- Eva Rodríguez-Míguez
- ECOBAS, Universidade de Vigo, GRIEE, 36310, Vigo, Spain.
- Instituto de Investigación Sanitaria Galicia Sur, Hospital Álvaro Cunqueiro, 36213, Vigo, Spain.
| | - Antonio Sampayo
- ECOBAS, Universidade de Santiago de Compostela, 15782, Santiago de Compostela, Spain
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Yang Z, Rand K, Stolk E, Busschbach J, Luo N. Exploring non-iterative time trade-off methods for valuation of EQ-5D-5L health states. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:1087-1094. [PMID: 38104294 DOI: 10.1007/s10198-023-01647-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION The composite time trade-off (cTTO) method is used as the primary method for valuing EQ-5D-5L health states, but it requires intensive interviewer training and stringent quality control, which increases the burden of conducting cTTO studies. In this study, two non-iterative variants of the TTO method, non-stopping TTO (nTTO) and open-ended TTO (oTTO), were tested head-to-head with the cTTO method aiming to reduce the administration burden. METHODS 31 EQ-5D-5L health states from an orthogonal array was selected and valued by a general public sample in China. Data were collected by 7 interviewers with all interviewers performed an equal number of interviews using all three TTO methods. We compared the value distribution, logical consistency, administration burden, and modeling performance of these three TTO methods. RESULTS In total, 422 participants participated in the valuation interviews, with 139 using the nTTO method, 140 using the oTTO method, and 143 using the cTTO method. Both oTTO and nTTO methods saved around 10 min for conducting an interview. The mean values of three methods were similar with each method showed different characteristics in their value distributions. cTTO outperformed the other two methods in terms of modeling performance. DISCUSSION Both non-iterative TTO methods showed potential for valuing EQ-5D health states, although their data distributions and modeling performance were inferior to the cTTO method. The results of this study showed the potential of these two alternative non-iterative TTO methods.
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Affiliation(s)
- Zhihao Yang
- Department of Health Services Management, Guizhou Medical University, Guiyang, China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
| | - Kim Rand
- Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway
- Maths in Health B.V, Rotterdam, The Netherlands
| | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Jan Busschbach
- Section of Medical Psychiatry and Psychotherapy, Erasmus Medical Centrum, Rotterdam, The Netherlands
| | - Nan Luo
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, Singapore, Singapore.
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Peasgood T, Bailey C, Chen G, De Silva A, De Silva Perera U, Norman R, Shah K, Viney R, Devlin N. Rationale, conceptual issues, and resultant protocol for a mixed methods Person Trade Off (PTO) and qualitative study to estimate and understand the relative value of gains in health for children and young people compared to adults. PLoS One 2024; 19:e0302886. [PMID: 38829857 PMCID: PMC11146702 DOI: 10.1371/journal.pone.0302886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 04/11/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Economic evaluation of healthcare typically assumes that an identical health gain to different patients has the same social value. There is some evidence that the public may give greater value to gains for children and young people, although this evidence is not always consistent. We present a mixed methods study protocol where we aim to explore public preferences regarding health gains to children and young people relative to adults, in an Australian setting. METHODS This study is a Person Trade Off (PTO) choice experiment that incorporates qualitative components. Within the PTO questions, respondents will be asked to choose between treating different groups of patients that may differ in terms of patient characteristics and group size. PTO questions will be included in an online survey to explore respondent views on the relative value of health gains to different age groups in terms of extending life and improving different aspects of quality of life. The survey will also contain attitudinal questions to help understand the impact of question style upon reported preferences. Additionally, the study will test the impact of forcing respondents to express a preference between two groups compared with allowing them to report that the two groups are equivalent. One-to-one 'think aloud', semi-structured interviews will be conducted to explore a sub-sample of respondents' motivations and views in more detail. Focus groups will be conducted with members of the public to discuss the study findings and explore their views on the role of public preferences in health care prioritisation based on patient age. DISCUSSION Our planned study will provide valuable information to healthcare decision makers in Australia who may need to decide whether to pay more for health gains for children and young people compared with adults. Additionally, the methodological test of forcing respondent choice or allowing them to express equivalence will contribute towards developing best practice methods in PTO studies. The rationale for and advantages of the study approach and potential limitations are discussed in the protocol.
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Affiliation(s)
- Tessa Peasgood
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Division of Population Health, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Cate Bailey
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Ashwini De Silva
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Richard Norman
- School of Population Health, Curtin University, Perth, Australia
| | - Koonal Shah
- National Institute for Health and Care Excellence, London, United Kingdom
| | - Rosalie Viney
- Faculty of Health, Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Ultimo, Australia
| | - Nancy Devlin
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Sheen D, Peasgood T, Goranitis I. Eliciting Societal Preferences for Non-health Outcomes: A Person Trade-Off Study in the Context of Genomics. Clin Ther 2023; 45:710-718. [PMID: 37524571 DOI: 10.1016/j.clinthera.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE Economic evaluations of health technologies traditionally aim to maximize population health outcomes measured by using quality-adjusted life-years (QALYs). Non-health outcomes, however, may have high social value, and their exclusion has the potential to bias decisions regarding allocation of health care resources. This research positions Australian participants as societal decision-makers to explore their willingness to trade-off health gains in adults for non-health benefits in families with a child affected by a rare disease. METHODS To estimate the social value of the different health care interventions, a person trade-off (PTO) method was used. PTOs present participants with groups of beneficiaries that vary in terms of the number of individuals who will benefit, the individuals' characteristics, their expected benefits, or a combination, and ask which group should be prioritized. Each trade-off presented health gains from the treatment of moderate physical and mental health conditions described by the 3-level version of the EuroQol 5-Dimension (EQ-5D-3L) health states. The health gains in these groups were traded-off against non-health gains in families accessing diagnostic genomic testing, and equivalence values were calculated, using median and ratio of means methods, based on the ratio of the group sizes at the point of equivalence. Participants were recruited through Prolific and were stratified according to age, sex, and education. The impact of participant characteristics on equivalence values was assessed using Kruskal-Wallis H tests and ordinary least-squares log-linear regressions. FINDINGS Participants (N = 434) positioned as societal decision-makers were generally willing to trade-off adult health gains with the familial non-health benefits of genomic testing, showing a preference for valuing both types of outcomes within public health policy. The aggregation of preferences generated 2 weightings for genomic testing against each health treatment, an unadjusted value and a reweighted value to match target demographic characteristics. Converted into QALY value per test, it was found that participants valued the non-health benefits of genomic testing between 0.730 and 0.756 QALY. A minority of participants always prioritized diagnostic genomic testing over the physical (6.0%) or mental (4.6%) health treatments, with a larger minority always prioritizing the physical (15.4%) or mental (14.8%) health treatments. IMPLICATIONS The findings indicate that participants perceived the non-health parental benefits in children experiencing rare disease to have comparable value to health gains in adults experiencing the moderate physical or mental health conditions described using EQ-5D-3L. These findings suggest that the benefits of genomic tests would be underestimated if only health benefits are included in economic evaluations.
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Affiliation(s)
- Daniel Sheen
- Graduate School of Humanities and Social Sciences, University of Melbourne, Melbourne, Victoria, Australia; Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Tessa Peasgood
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ilias Goranitis
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Australian Genomics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
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Kennedy K, Pickard S, Tarride JE, Xie F. Resurrecting Multiattribute Utility Function: Developing a Value Set for Health Utility for Glaucoma. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023:S1098-3015(23)02530-5. [PMID: 37059392 DOI: 10.1016/j.jval.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVES This study aimed to develop a scoring function to calculate health utilities for health states described by the Health Utility for Glaucoma (HUG-5) based on the preferences of the general population in the United States. METHODS Preferences for HUG-5 health states were elicited using the standard gamble and visual analog scale through an online survey. Quota-based sampling was used to recruit a representative sample of the US general population in terms of age, sex, and race. A multiple attribute disutility function (MADUF) approach was adopted to derive scoring for the HUG-5. Model fit was assessed using mean absolute error associated with 5 HUG-5 marker health states that describe mild/moderate and severe glaucoma. RESULTS Of 634 respondents completing the tasks, 416 were included in the estimation of the MADUF; 260 respondents (63%) considered worst possible HUG-5 health state better than death. The preferred scoring function generates the utilities ranging from 0.05 (worst HUG-5 health state) to 1 (best HUG-5 health state). The correlation between mean elicited and estimated values for marker states was strong (R2 = 0.97) with mean absolute error = 0.11. CONCLUSIONS The MADUF for HUG-5 is used to measure health utilities on the scale of perfect health and death, which can be used to estimate quality-adjusted life-years for economic evaluations of glaucoma interventions.
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Affiliation(s)
- Kevin Kennedy
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Simon Pickard
- College of Pharmacy - Pharmacy Systems Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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Enhancing Healthcare Decision-Making Process: Findings from Orthopaedic Field. ADMINISTRATIVE SCIENCES 2020. [DOI: 10.3390/admsci10040094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
In the healthcare field, the decision-making process is part of the broad spectrum of “clinical reasoning”, which is recognised as the whole process by which a physician decides about patients’ treatments and cares. Several clinicians’ intrinsic variables lead to this decisional path. Little is known about the inference of these variables in triggering biases in decisions about the post-discharge period in the surgical field. Accordingly, this research aims to understand if and how cognitive biases can affect orthopaedists in decision-making regarding the follow-up after knee and hip arthroplasty. To achieve this goal, an interview-based explorative case study was run. Three key-decisional orthopaedic surgeons were interviewed through a quality control tool aimed at monitoring the causes and effects of cognitive distortions. Coherently with the literature, eight biases come to light. All the interviewees agree on the presence of four common biases in orthopaedic surgery (Affect heuristic, Anchoring, Halo effect, Saliency). The other biases (Groupthink, Availability, Overconfidence, Confirmation), instead, depending on specific physicians’ intrinsic variables; namely: (i) working experience; (ii) working context. This finding contributes to the debate about the application of cognitive tools as leverage for improving the quality of clinical decision-making process and, indirectly, enhancing better healthcare outcomes.
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Luo N, Augestad L, Rand K. Testing the "Nonstopping" Time Trade-Off: Is It Better Than the Composite Time Trade-Off? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1489-1496. [PMID: 33127020 DOI: 10.1016/j.jval.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES There are several issues of concern for the composite time trade-off (c-TTO) used to estimate EQ-5D-5L value sets. The "nonstopping" TTO (n-TTO) differs from the c-TTO mainly in 2 aspects: (1) n-TTO uses a standardized top-down or bottom-up routing; and (2) n-TTO continues when indifference is indicated by respondents. In this study, we aimed to test the feasibility of n-TTO and compared it with c-TTO. METHODS The study was conducted in parallel in Norway and Singapore. In both countries, members of the general population were invited to complete 10 n-TTO or c-TTO tasks. Acceptability and feasibility of n-TTO were assessed using respondents' feedback, administration time, and valuation success rate. Characteristics of the TTO data derived from c-TTO and n-TTO tasks were examined at task, individual, as well as group levels. RESULTS In both Norway and Singapore, the success rate of n-TTO tasks was high (> 95%) and the n-TTO tasks took less time to complete than the c-TTO tasks, and there were fewer or smaller "spikes" in the distributions of n-TTO data compared to c-TTO data. In Norway, the individual-level n-TTO and c-TTO data had similar distribution and logical consistency profiles. In Singapore, n-TTO was inferior to c-TTO in logical consistency; however, a similar degree of nonmonotonicity was observed in modeling of n-TTO and c-TTO data. CONCLUSIONS The noniterative n-TTO appeared to be feasible and may generate data with better distribution in shorter time than c-TTO. Further research is needed to assess this new health-state valuation method.
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Affiliation(s)
- Nan Luo
- Saw Swee Hoch School of Public Health, National University of Singapore, Singapore.
| | - Liv Augestad
- Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kim Rand
- The Health Services Research Unit - HØKH, Akershus University Hospital, Lørenskog, Norway
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A General Population Utility Valuation Study for Metastatic Epidural Spinal Cord Compression Health States. Spine (Phila Pa 1976) 2019; 44:943-950. [PMID: 31205172 DOI: 10.1097/brs.0000000000002975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN General population utility valuation study. OBJECTIVE This study obtained utility valuations from a Canadian general population perspective for 31 unique metastatic epidural spinal cord compression (MESCC) health states and determined the relative importance of MESCC-related consequences on quality-of-life. SUMMARY OF BACKGROUND DATA Few prospective studies on the treatment of MESCC have collected quality-adjusted-life-year weights (termed "utilities"). Utilities are an important summative measure which distills health outcomes to a single number that can assist healthcare providers, patients, and policy makers in decision making. METHODS We recruited a sample of 1138 adult Canadians using a market research company. Quota sampling was used to ensure that the participants were representative of the Canadian population in terms of age, sex, and province of residence. Using the validated MESCC module for the "Self-administered Online Assessment of Preferences" (SOAP) tool, participants were asked to rate six of the 31 MESCC health states, each of which presented varying severities of five MESCC-related dysfunctions (dependent; non-ambulatory; incontinent; pain; other symptoms). RESULTS Participants equally valued all MESCC-related dysfunctions which followed a pattern of diminishing marginal disutility (each additional consequence resulted in a smaller incremental decrease in utility than the previous). These results demonstrate that the general population values physical function equal to other facets of quality-of-life. CONCLUSION We provide a comprehensive set of ex ante utility estimates for MESCC health states that can be used to help inform decision making. This is the first study reporting direct utility valuation for a spinal disorder. Our methodology offers a feasible solution for obtaining quality-of-life data without collecting generic health status questionnaire responses from patients. LEVEL OF EVIDENCE 4.
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Pahuta M, Frombach A, Hashem E, Spence S, Sun C, Wai EK, Werier J, van Walraven C, Coyle D. The Psychometric Properties of a Self-Administered, Open-Source Module for Valuing Metastatic Epidural Spinal Cord Compression Utilities. PHARMACOECONOMICS - OPEN 2019; 3:197-204. [PMID: 30178420 PMCID: PMC6533369 DOI: 10.1007/s41669-018-0092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Web surveys are often used for utility valuation. Typically, custom utility valuation tools that have not undergone psychometric evaluation are used. OBJECTIVES This study aimed to determine the psychometric properties of a metastatic epidural spinal cord compression (MESCC) module run on a customizable open-source, internet-based, self-directed utility valuation platform (Self-directed Online Assessment of Preferences [SOAP]). METHODS Individuals accompanying patients to the emergency department waiting room in Ottawa, Canada, were recruited. Participants made SOAP MESCC health state valuations in the waiting room and 48 h later at home. Validity, agreement reliability, and responsiveness were measured by logical consistency of responses, smallest detectable change, the interclass correlation coefficient, and Guyatt's responsiveness index, respectively. RESULTS Of 285 participants who completed utility valuations, only 113 (39.6%) completed the re-test. Of these 113 participants, 92 (81.4%) provided valid responses on the first test and 75 (66.4%) provided valid responses on the test and re-test. Agreement for all groups of health states was adequate, since their smallest detectable change was less than the minimal clinically important difference. The mean interclass correlation coefficients for all health states were > 0.8, indicating at least substantial reliability. Guyatt's responsiveness indices all exceeded 0.80, indicating a high level of responsiveness. CONCLUSIONS To our knowledge, this is the first validated open-source, web-based, self-directed utility valuation module. We have demonstrated the SOAP MESCC module is valid, reproducible, and responsive for obtaining ex ante utilities. Considering the successful psychometric validation of the SOAP MESCC module, other investigators can consider developing modules for other diseases where direct utility valuation is needed.
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Affiliation(s)
- Markian Pahuta
- Department of Orthopaedic Surgery, Henry Ford Health System, 2799 West Grand Blvd, CFP-6, Detroit, MI USA
| | | | | | | | | | - Eugene K. Wai
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON Canada
| | - Joel Werier
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON Canada
| | - Carl van Walraven
- Department of Epidemiology and Community Medicine, Institute for Clinical Evaluative Sciences, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
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García-Molina M, Chicaiza-Becerra LA. Anchoring bias in face-to-face Time-Trade-Off valuations of health states. Rev Salud Publica (Bogota) 2018; 19:686-690. [PMID: 30183818 DOI: 10.15446/rsap.v19n5.60924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/08/2017] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To test whether anchoring (a cognitive bias) occurs during face-to-face interviews to value health states by Time-Trade-Off. METHODS 147 Colombian subjects (111 males, 36 females) valued five EQ-5D health states better than death during a face-to-face interview. Subjects were randomly assigned to two different starting points. RESULTS Shapiro-Wilk test discarded normality, while non-parametric tests, including Kolmogorov-Smirnov and Wilcoxon-Mann-Whitney, showed that anchoring was significant in four out of five health states. A higher starting point increased the elicited value by 15 %-188 %. The size of the anchoring effect was not uniform among health states. CONCLUSION Anchoring effects may bias face-to-face Time Trade-Off valuations. The size of the anchoring effect is relevant enough for health policy.
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Affiliation(s)
- Mario García-Molina
- MG: Econ. M. Sc. M. Phil, Ph. D. Universidad Nacional de Colombia. Bogotá, Colombia.
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Wong ELY, Ramos-Goñi JM, Cheung AWL, Wong AYK, Rivero-Arias O. Assessing the Use of a Feedback Module to Model EQ-5D-5L Health States Values in Hong Kong. THE PATIENT 2018; 11:235-247. [PMID: 29019161 PMCID: PMC5845074 DOI: 10.1007/s40271-017-0278-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND An international valuation protocol exists for obtaining societal values for each of the 3125 health states of the five-level EuroQol-five dimensions (EQ-5D-5L) questionnaire. A feedback module (FM) that can be related to theoretical models used in behavioral economics was recently included in this protocol. OBJECTIVES Our objective was to assess the impact of using an FM to estimate an EQ-5D-5L value set in Hong Kong. METHODS EQ-5D-5L health states were elicited using a composite time trade-off (C-TTO) and a discrete-choice (DC) experiment. Use of the FM according to participant characteristics and the impact of the FM on the number of inconsistent C-TTO responses were assessed. We employed a main-effects hybrid model that combined data from both elicitation techniques. RESULTS In total, 1014 individuals completed the survey. The sample was representative of the general Chinese Hong Kong population in terms of sex, educational attainment, marital status, and most age groups but not for employment status. The use of the FM reduced the number of C-TTO inconsistencies. Participant characteristics differed significantly between those who used and did not use the FM. The model without a constant resulted in logical consistent coefficients and was therefore selected as the model to produce the value set. The predicted EQ-5D-5L values ranged from -0.864 to 1. CONCLUSIONS The use of an FM to allow participants to exclude C-TTO responses reduced the number of inconsistent responses and improved the quality of the data when estimating an EQ-5D-5L value set in Hong Kong.
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Affiliation(s)
- Eliza L Y Wong
- The JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Annie W L Cheung
- The JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Amy Y K Wong
- The JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
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Attema AE, Krol M, van Exel J, Brouwer WBF. New findings from the time trade-off for income approach to elicit willingness to pay for a quality adjusted life year. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:277-291. [PMID: 28275878 PMCID: PMC5813059 DOI: 10.1007/s10198-017-0883-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 02/23/2017] [Indexed: 05/05/2023]
Abstract
In this paper we empirically investigate how to appropriately model utility of wealth and health. We use a recently proposed alternative approach to value willingness to pay (WTP) for health, making use of trade-offs between income and life years or quality of life, which we extend to allow for a more realistic multiplicative utility function over health and money. Moreover, we show how reference-dependency can be incorporated into this model and derive its predictions for WTP elicitation. We propose three experimental elicitation procedures and test these in a feasibility study, analysing the responses under different assumptions about the discount rate. Several interesting results are reported: first, the data are highly skewed, but if we trim the 5% lowest and highest values, we obtain plausible WTP estimates. Second, the results differ considerably between procedures, indicating that WTP estimates are sensitive to the assumed utility function. Third, respondents appear to be loss averse for both health and money, which is consistent with assumptions from prospect theory. Finally, our results also indicate that respondents are more willing to trade quality of life than life years.
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Affiliation(s)
- Arthur E Attema
- iBMG, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Marieke Krol
- iBMG, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Merck B.V., Tupolevlaan 41-61, 1119 NW, Schiphol-Rijk, The Netherlands
| | - Job van Exel
- iBMG, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Werner B F Brouwer
- iBMG, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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