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Cantarero Prieto D, Lanza-León P, Moreno P, Lera J, Gonzalez F, González Rodríguez I, Blázquez-Fernández C. Coronavirus fear of contagion and compliance with social distancing measures: evidence for a sample of a Spanish university community. PeerJ 2023; 11:e14771. [PMID: 36879912 PMCID: PMC9985414 DOI: 10.7717/peerj.14771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/30/2022] [Indexed: 03/05/2023] Open
Abstract
Background Social distancing measures have been one of the core pillars of the strategy against COVID-19 in all the countries. This study aims at understanding what motivates behaviours and compliance with social distancing measures among students and workers from a Spanish public university. Methods We carry out two logistics models considering two different dependent variables: not maintaining social relation with non-cohabiting people and not to leave home except for emergencies (n = 507, sample is formed by students and workers from the University of Cantabria in the North of Spain). Results Being very concerned about getting ill suggests higher risk of not maintaining social relation with non-cohabiting people. Getting older increase the probability of not leaving home except for emergencies as happens with those who are very concerned about getting ill. Young people often living with vulnerable older relatives may affect students' behaviour. Conclusions Our findings suggest that compliance with social distancing measures depends on several factors related to age, the number or kind of cohabiting people and level of concern about getting ill. Policies should address all these factors through a multidisciplinary perspective.
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Affiliation(s)
- David Cantarero Prieto
- Departamento de Economía, Universidad de Cantabria, Santander, Cantabria, Spain.,Research Group of Health Economics and Health Services Management, Valdecilla Biomedical Institute Research (IDIVAL), Santander, Cantabria, Spain
| | - Paloma Lanza-León
- Departamento de Economía, Universidad de Cantabria, Santander, Cantabria, Spain.,Research Group of Health Economics and Health Services Management, Valdecilla Biomedical Institute Research (IDIVAL), Santander, Cantabria, Spain
| | - Patricia Moreno
- Departamento de Economía Aplicada y Métodos Cuantitativos, Universidad de La Rioja, Logroño, La Rioja, Spain
| | - Javier Lera
- Research Group of Health Economics and Health Services Management, Valdecilla Biomedical Institute Research (IDIVAL), Santander, Cantabria, Spain
| | - Francisco Gonzalez
- Research Group of Health Economics and Health Services Management, Valdecilla Biomedical Institute Research (IDIVAL), Santander, Cantabria, Spain.,Primary Care, Cantabria Health Service, Santander, Cantabria, Spain
| | | | - Carla Blázquez-Fernández
- Departamento de Economía, Universidad de Cantabria, Santander, Cantabria, Spain.,Research Group of Health Economics and Health Services Management, Valdecilla Biomedical Institute Research (IDIVAL), Santander, Cantabria, Spain
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2
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Wilson AM, Mussio I, Chilton S, Gerald LB, Jones RM, Drews FA, LaKind JS, Beamer PI. A Novel Application of Risk-Risk Tradeoffs in Occupational Health: Nurses' Occupational Asthma and Infection Risk Perceptions Related to Cleaning and Disinfection during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16092. [PMID: 36498164 PMCID: PMC9736618 DOI: 10.3390/ijerph192316092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 06/08/2023]
Abstract
BACKGROUND Nurses face the risk of new onset occupational asthma (OA) due to exposures to cleaning and disinfection (C&D) agents used to prevent infections in healthcare facilities. The objective of this study was to measure nurses' preferences when presented with simultaneous OA and respiratory viral infection (e.g., COVID-19) risks related to increased/decreased C&D activities. METHODS Nurses working in healthcare for ≥1 year and without physician-diagnosed asthma were recruited for an online anonymous survey, including four risk-risk tradeoff scenarios between OA and respiratory infection with subsequent recovery (Infect and Recovery) or subsequent death (Infect and Death). Nurses were presented with baseline risks at hypothetical "Hospital 1", and were asked to choose Hospital 2 (increased OA risk to maintain infection risk), Hospital 3 (increased infection risk to maintain OA risk), or indicate that they were equally happy. RESULTS Over 70% of nurses were willing to increase infection risk to maintain baseline OA risk if they were confident they would recover from the infection. However, even when the risk of infection leading to death was much lower than OA, most nurses were not willing to accept a larger (but still small) risk of death to avoid doubling their OA risk. Age, work experience, and ever having contracted or knowing anyone who has contracted a respiratory viral infection at work influenced choices. CONCLUSIONS We demonstrate the novel application of a risk-risk tradeoff framework to address an occupational health issue. However, more data are needed to test the generalizability of the risk preferences found in this specific risk-risk tradeoff context.
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Affiliation(s)
- Amanda M. Wilson
- Department of Community, Environment & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724, USA
| | - Irene Mussio
- Business School (Economics), Newcastle University, 5 Barrack Rd., Newcastle upon Tyne NE1 4SE, UK
| | - Susan Chilton
- Business School (Economics), Newcastle University, 5 Barrack Rd., Newcastle upon Tyne NE1 4SE, UK
| | - Lynn B. Gerald
- Population Health Sciences Program, Office of the Vice Chancellor for Health Affairs, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Rachael M. Jones
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA
| | - Frank A. Drews
- Department of Psychology, College of Social & Behavioral Science, University of Utah, 380 1530 E, Salt Lake City, UT 84112, USA
| | - Judy S. LaKind
- LaKind Associates, LLC, 106 Oakdale Ave., Baltimore, MD 21228, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Paloma I. Beamer
- Department of Community, Environment & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724, USA
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Lipman SA, Attema AE, Versteegh MM. Correcting for discounting and loss aversion in composite time trade-off. HEALTH ECONOMICS 2022; 31:1633-1648. [PMID: 35474364 PMCID: PMC9541376 DOI: 10.1002/hec.4529] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 05/14/2023]
Abstract
Time trade-off utilities have been suggested to be biased upwards. This bias is a result of the method being applied assuming linear utility of life duration, which is violated when individuals discount future life years or are loss averse for health. Applying a "corrective approach", that is, measuring individuals' discount function and loss aversion and correcting time trade-off utilities for these individual characteristics, may reduce this bias in utilities. Earlier work has developed this approach for time trade-off in a student sample. In this study, the corrective approach was extended to composite time trade-off (cTTO) methodology, which enabled correcting utilities for health states worse than dead. In digital interviews a sample of 150 members of the general public completed cTTO tasks for six health states, and afterward they completed measurements of loss aversion and discounting. cTTO utilities were corrected using these measurements under multiple specifications. Respondents were also asked to reflect on and adjust their cTTO utilities directly. Our results show considerable loss aversion and both positive and negative discounting were prevalent. As predicted, correction generally resulted in lower utilities. This was in accordance with the direction of adjustments made by respondents themselves.
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Affiliation(s)
- Stefan A. Lipman
- Erasmus Centre for Health Economics RotterdamErasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamNetherlands
| | - Arthur E. Attema
- Erasmus Centre for Health Economics RotterdamErasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamNetherlands
| | - Matthijs M. Versteegh
- Institute for Medical Technology AssessmentErasmus University RotterdamRotterdamNetherlands
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4
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Lipman SA, Brouwer WBF, Attema AE. Living up to expectations: Experimental tests of subjective life expectancy as reference point in time trade-off and standard gamble. JOURNAL OF HEALTH ECONOMICS 2020; 71:102318. [PMID: 32229049 DOI: 10.1016/j.jhealeco.2020.102318] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 05/05/2023]
Abstract
Earlier work suggested that subjective life expectancy (SLE) functions as reference point in time trade-off (TTO), but has not tested or modelled this explicitly. In this paper we construct a model based on prospect theory to investigate these predictions more thoroughly. We report the first experimental test of reference-dependence with respect to SLE for TTO and extend this approach to standard gamble (SG). In two experiments, subjects' SLEs were used to construct different versions of 10-year TTO and SG tasks, with the gauge duration either described as occurring above or below life expectation. Our analyses suggest that both TTO and SG weights were affected by SLE as predicted by prospect theory with SLE as reference point. Subjects gave up fewer years in TTO and were less risk-tolerant in SG below SLE, implying that weights derived from these health state valuation methods for durations below SLE will be biased upwards.
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Affiliation(s)
- Stefan A Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands.
| | - Werner B F Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Arthur E Attema
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands
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5
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Lipman SA, Brouwer WB, Attema AE. QALYs without bias? Nonparametric correction of time trade-off and standard gamble weights based on prospect theory. HEALTH ECONOMICS 2019; 28:843-854. [PMID: 31237093 PMCID: PMC6618285 DOI: 10.1002/hec.3895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 12/21/2018] [Accepted: 03/11/2019] [Indexed: 05/20/2023]
Abstract
Common health state valuation methodologies, such as standard gamble (SG) and time trade-off (TTO), typically produce different weights for identical health states. We attempt to alleviate these differences by correcting the confounding influences modeled in prospect theory: loss aversion and probability weighting. Furthermore, we correct for nonlinear utility of life duration. In contrast to earlier attempts at correcting TTO and SG weights, we measure and correct all these tenets simultaneously, using newly developed nonparametric methodology. These corrections were applied to three less-than-perfect health states, measured with TTO and SG. We found considerable loss aversion and probability weighting for both gains and losses in life years, and we observe concave utility for gains and convex utility for losses in life years. After correction, the initially significant differences in weights between TTO and SG disappeared for all health states. Our findings suggest new opportunities to account for bias in health state valuations but also the need for further validation of resulting weights.
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Affiliation(s)
- Stefan A. Lipman
- Erasmus School of Health Policy & Management (ESHPM)Erasmus University RotterdamRotterdamThe Netherlands
| | - Werner B.F. Brouwer
- Erasmus School of Health Policy & Management (ESHPM)Erasmus University RotterdamRotterdamThe Netherlands
| | - Arthur E. Attema
- Erasmus School of Health Policy & Management (ESHPM)Erasmus University RotterdamRotterdamThe Netherlands
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6
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Lipman SA, Brouwer WBF, Attema AE. The Corrective Approach: Policy Implications of Recent Developments in QALY Measurement Based on Prospect Theory. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:816-821. [PMID: 31277829 DOI: 10.1016/j.jval.2019.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 05/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Common health state valuation methodology, such as time tradeoff (TTO) and standard gamble (SG), is typically applied under several descriptively invalid assumptions, for example, related to linear quality-adjusted life years (QALYs) or expected utility (EU) theory. Hence, the current use of results from health state valuation exercises may lead to biased QALY weights, which may in turn affect decisions based on economic evaluations using such weights. Methods have been proposed to correct responses for the biases associated with different health state valuation techniques. In this article we outline the relevance of prospect theory (PT), which has become the dominant descriptive alternative to EU, for health state valuations and economic evaluations. METHODS AND RESULTS We provide an overview of work in this field, which aims to remove biases from QALY weights. We label this "the corrective approach." By quantifying PT parameters, such as loss aversion, probability weighting, and nonlinear utility, it may be possible to correct TTO and SG responses for biases in an attempt to produce more valid estimates of preferences for health states. Through straightforward examples, this article illustrates the effects of this corrective approach and discusses several unresolved issues that currently limit the relevance of corrected weights for policy. CONCLUSIONS Suggestions for research addressing these issues are provided. Nonetheless, if validly corrected health state valuations become available, we argue in favor of using these in economic evaluations.
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Affiliation(s)
- Stefan A Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, DR Rotterdam, The Netherlands.
| | - Werner B F Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, DR Rotterdam, The Netherlands
| | - Arthur E Attema
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, DR Rotterdam, The Netherlands
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7
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Constantinople CM, Piet AT, Brody CD. An Analysis of Decision under Risk in Rats. Curr Biol 2019; 29:2066-2074.e5. [PMID: 31155352 PMCID: PMC6863753 DOI: 10.1016/j.cub.2019.05.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/06/2019] [Accepted: 05/01/2019] [Indexed: 01/29/2023]
Abstract
In 1979, Daniel Kahneman and Amos Tversky published a ground-breaking paper titled "Prospect Theory: An Analysis of Decision under Risk," which presented a behavioral economic theory that accounted for the ways in which humans deviate from economists' normative workhorse model, Expected Utility Theory [1, 2]. For example, people exhibit probability distortion (they overweight low probabilities), loss aversion (losses loom larger than gains), and reference dependence (outcomes are evaluated as gains or losses relative to an internal reference point). We found that rats exhibited many of these same biases, using a task in which rats chose between guaranteed and probabilistic rewards. However, prospect theory assumes stable preferences in the absence of learning, an assumption at odds with alternative frameworks such as animal learning theory and reinforcement learning [3-7]. Rats also exhibited trial history effects, consistent with ongoing learning. A reinforcement learning model in which state-action values were updated by the subjective value of outcomes according to prospect theory reproduced rats' nonlinear utility and probability weighting functions and also captured trial-by-trial learning dynamics.
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Affiliation(s)
| | - Alex T Piet
- Princeton Neuroscience Institute, Princeton University, Washington Road, Princeton, NJ 08544, USA
| | - Carlos D Brody
- Princeton Neuroscience Institute, Princeton University, Washington Road, Princeton, NJ 08544, USA; Department of Molecular Biology, Princeton University, Washington Road, Princeton, NJ 08544, USA; Howard Hughes Medical Institute, Princeton University, Washington Road, Princeton, NJ 08544, USA
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8
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Ayvaci MUS, Alagoz O, Ahsen ME, Burnside ES. Preference-Sensitive Management of Post-Mammography Decisions in Breast Cancer Diagnosis. PRODUCTION AND OPERATIONS MANAGEMENT 2018; 27:2313-2338. [PMID: 31031555 PMCID: PMC6481963 DOI: 10.1111/poms.12897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Decision models representing the clinical situations where treatment options entail a significant risk of morbidity or mortality should consider the variations in risk preferences of individuals. In this study, we develop a stochastic modeling framework that optimizes risk-sensitive diagnostic decisions after a mammography exam. For a given patient, our objective is to find the utility maximizing diagnostic decisions where we define the utility over quality-adjusted survival duration. We use real data from a private mammography database to numerically solve our model for various utility functions. Our choice of utility functions for the numerical analysis is driven by actual patient behavior encountered in clinical practice. We find that invasive diagnostic procedures such as biopsies are more aggressively used than what the optimal risk-neutral policy would suggest, implying a far-sighted (or equivalently risk-seeking) behavior. When risk preferences are incorporated into the clinical practice, policy makers should bear in mind that a welfare loss in terms of survival duration is inevitable as evidenced by our structural and empirical results.
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Affiliation(s)
- Mehmet Ulvi Saygi Ayvaci
- Information Systems, Naveen Jindal School of Management, University of Texas at Dallas, 800 W Campbell Rd SM33, Richardson, Texas 75080, USA,
| | - Oguzhan Alagoz
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, Wisconsin 53705, USA,
| | - Mehmet Eren Ahsen
- Icahn School of Medicine at Mount Sinai, San Francisco, California 94108, USA,
| | - Elizabeth S Burnside
- Department of Radiology, University of Wisconsin, Madison, Wisconsin 53792, USA,
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9
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Reference-dependent preferences on smart phones in South Korea: Focusing on attributes with heterogeneous preference direction. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2016.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Doctor JN, Huesch MD, Meeker D. Rethinking the value of survival: clinical trials should measure patient preferences for survival on entry to trials. J Clin Epidemiol 2016; 77:137-138. [PMID: 27164276 DOI: 10.1016/j.jclinepi.2016.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 03/14/2016] [Accepted: 03/31/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Jason N Doctor
- Department of Pharmaceutical Health and Economics, Schaeffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Los Angeles, CA 90089-3333, USA.
| | - Marco D Huesch
- Sol Price School of Public Policy, Schaeffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Los Angeles, CA 90089-3333, USA
| | - Daniella Meeker
- Department of Preventive Medicine, University of Southern California, 1450 Biggy Street, Building #288, Los Angeles, CA 90033, USA
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Attema AE, Brouwer WBF, l'Haridon O, Pinto JL. Estimating sign-dependent societal preferences for quality of life. JOURNAL OF HEALTH ECONOMICS 2015; 43:229-243. [PMID: 26263893 DOI: 10.1016/j.jhealeco.2015.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 07/06/2015] [Accepted: 07/22/2015] [Indexed: 06/04/2023]
Abstract
This paper is the first to apply prospect theory to societal health-related decision making. In particular, we allow for utility curvature, equity weighting, sign-dependence, and loss aversion in choices concerning quality of life of other people. We find substantial inequity aversion, both for gains and losses, which can be attributed to both diminishing marginal utility and differential weighting of better-off and worse-off. There are also clear framing effects, which violate expected utility. Moreover, we observe loss aversion, indicating that subjects give more weight to one group's loss than another group's gain of the same absolute magnitude. We also elicited some information on the effect of the age of the studied group. The amount of inequity aversion is to some extent influenced by the age of the considered patients. In particular, more inequity aversion is observed for gains of older people than gains of younger people.
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Affiliation(s)
- Arthur E Attema
- iBMG, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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12
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Ruggeri M, Coretti S. Do Probability and Certainty Equivalent Techniques Lead to Inconsistent Results? Evidence from Gambles Involving Life-Years and Quality of Life. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:413-424. [PMID: 26091595 DOI: 10.1016/j.jval.2014.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/19/2014] [Accepted: 12/22/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Within the standard gamble approach to the elicitation of health preferences, no previous studies compared probability equivalent (PE) and certainty equivalent (CE) techniques OBJECTIVE This study aimed to explore the differences between CE and PE techniques when payoffs are expressed in terms of life-years or quality of life. METHODS Individuals were interviewed through both CE and PE techniques within an experimental setting. Inferential statistics and regression analysis where applied to process data. Order and sequence effect were also investigated. RESULTS On average, the elicitation technique did not affect individuals' risk attitude significantly. Individuals proved to be risk averse in gambles concerning life-years and risk seekers in those concerning quality of life. No order or sequence effect was observed. Risk premium, measuring the strength of risk attitude as the percentage variation between the individual's estimated PE or CE and the risk neutral PE or CE, was affected by the kind of gamble that the interviewee is presented with. It increased in gambles concerning health profiles, denoting a stronger risk propensity, and decreased in gambles concerning life years, denoting a stronger risk aversion. CONCLUSION The choice of the elicitation technique did not affect the individuals' risk attitude significantly, which instead was sensitive to the kind of gamble.
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Affiliation(s)
- Matteo Ruggeri
- Institute of Policy and Economics, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Silvia Coretti
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Robinson A, Spencer A, Moffatt P. A framework for estimating health state utility values within a discrete choice experiment: modeling risky choices. Med Decis Making 2014; 35:341-50. [PMID: 25349189 DOI: 10.1177/0272989x14554715] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There has been recent interest in using the discrete choice experiment (DCE) method to derive health state utilities for use in quality-adjusted life year (QALY) calculations, but challenges remain. OBJECTIVES We set out to develop a risk-based DCE approach to derive utility values for health states that allowed 1) utility values to be anchored directly to normal health and death and 2) worse than dead health states to be assessed in the same manner as better than dead states. Furthermore, we set out to estimate alternative models of risky choice within a DCE model. METHOD A survey was designed that incorporated a risk-based DCE and a "modified" standard gamble (SG). Health state utility values were elicited for 3 EQ-5D health states assuming "standard" expected utility (EU) preferences. The DCE model was then generalized to allow for rank-dependent expected utility (RDU) preferences, thereby allowing for probability weighting. A convenience sample of 60 students was recruited and data collected in small groups. RESULTS Under the assumption of "standard" EU preferences, the utility values derived within the DCE corresponded fairly closely to the mean results from the modified SG. Under the assumption of RDU preferences, the utility values estimated are somewhat lower than under the assumption of standard EU, suggesting that the latter may be biased upward. CONCLUSION Applying the correct model of risky choice is important whether a modified SG or a risk-based DCE is deployed. It is, however, possible to estimate a probability weighting function within a DCE and estimate "unbiased" utility values directly, which is not possible within a modified SG. We conclude by setting out the relative strengths and weaknesses of the 2 approaches in this context.
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Affiliation(s)
| | - Anne Spencer
- University of Exeter Medical School, Exeter, UK (AS)
| | - Peter Moffatt
- University of East Anglia, Norwich, United Kingdom (AR, PM)
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14
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Neuman E. Reference-dependent preferences for maternity wards: an exploration of two reference points. Health Psychol Behav Med 2014; 2:440-447. [PMID: 25750793 PMCID: PMC4346021 DOI: 10.1080/21642850.2014.881257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/06/2014] [Indexed: 10/31/2022] Open
Abstract
It is now well established that a person's valuation of the benefit from an outcome of a decision is determined by the intrinsic "consumption utility" of the outcome itself and also by the relation of the outcome to some reference point. The most notable expression of such reference-dependent preferences is loss aversion. What precisely this reference point is, however, is less clear. This paper claims and provides empirical evidence for the existence of more than one reference point. Using a discrete choice experiment in the Israeli public health-care sector, within a sample of 219 women who had given birth, it is shown that respondents refer to two reference points: (i) a constant scenario that is used in the experiment; and (ii) also the actual state of the quantitative attributes of the service (number of beds in room of hospitalization; and travel time from residence to hospital). In line with the loss aversion theory, it is also shown that losses (vis-à-vis the constant scenario and vis-à-vis the actual state) accumulate and have reinforced effects, while gains do not.
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Affiliation(s)
- Einat Neuman
- Department of Economics, College of Management , Rabin Street, Rishon Le'Tzion , Israel
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15
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Attema AE, Brouwer WBF, I'Haridon O. Prospect theory in the health domain: a quantitative assessment. JOURNAL OF HEALTH ECONOMICS 2013; 32:1057-65. [PMID: 24103499 DOI: 10.1016/j.jhealeco.2013.08.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 08/13/2013] [Accepted: 08/22/2013] [Indexed: 05/07/2023]
Abstract
It is well-known that expected utility (EU) has empirical deficiencies. Cumulative prospect theory (CPT) has developed as an alternative with more descriptive validity. However, CPT's full function had not yet been quantified in the health domain. This paper is therefore the first to simultaneously measure utility of life duration, probability weighting, and loss aversion in this domain. We observe loss aversion and risk aversion for gains and losses, which for gains can be explained by probabilistic pessimism. Utility for gains is almost linear. For losses, we find less weighting of probability 1/2 and concave utility. This contrasts with the common finding of convex utility for monetary losses. However, CPT was proposed to explain choices among lotteries involving monetary outcomes. Life years are arguably very different from monetary outcomes and need not generate convex utility for losses. Moreover, utility of life duration reflects discounting, causing concave utility.
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Affiliation(s)
- Arthur E Attema
- iBMG/iMTA, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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16
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Savings, subgoals, and reference points. JUDGMENT AND DECISION MAKING 2013. [DOI: 10.1017/s1930297500004459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractDecision makers often save money for a specific goal by forgoing discretionary consumption and instead putting the money toward the savings goal. We hypothesized that reference points can be exploited to enhance this type of saving. In two hypothetical scenario studies, subjects made judgments of their likelihood to forgo a small expenditure in order to put the money toward the savings goal. In Experiment 1, judgments were higher if the savings goal was presented as composed of weekly subgoals (e.g., save $60 per week to buy a $180 iPod). Experiment 2 replicated this finding and demonstrated that the subgoal manipulation increased judgments of likelihood to save money only when the money saved from the foregone consumption would allow the decision maker to meet the weekly subgoal exactly (not under or overshoot it). These results suggest a reference point mechanism and point to ways that behavioral decision research can be harnessed to improve economic behaviors.
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Petrillo J, Cairns J. Converting condition-specific measures into preference-based outcomes for use in economic evaluation. Expert Rev Pharmacoecon Outcomes Res 2012; 8:453-61. [PMID: 20528330 DOI: 10.1586/14737167.8.5.453] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Quality-adjusted life-years (QALYs) play an important role in reimbursement decisions when one of the criteria is the cost-effectiveness of the health technology. While for many generic QALYs (e.g., based on the EQ-5D) are viewed as the gold standard, there has been a considerable increase in interest in using condition-specific data to generate QALYs. There are two main methods: mapping from the condition-specific data to a generic health-related quality of life measure; and direct valuation of condition-specific health states. Whether one believes condition-specific data are useful even if generic QALY data are available, or simply that condition-specific data are helpful in the absence of generic measures of health-related quality of life, it is timely to review recent research activity directed at making greater use of condition-specific data to inform assessments of cost-effectiveness.
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Affiliation(s)
- Jennifer Petrillo
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; United BioSource Corporation, 20 Bloomsbury Square, London WC1A 2NS, UK.
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Attema AE, Brouwer WBF. A test of independence of discounting from quality of life. JOURNAL OF HEALTH ECONOMICS 2012; 31:22-34. [PMID: 22277284 DOI: 10.1016/j.jhealeco.2011.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 11/21/2011] [Accepted: 12/12/2011] [Indexed: 05/05/2023]
Abstract
The quality-adjusted life-years (QALY) model assumes quality and quantity of life can be multiplied into a single index and requires quality and quantity to be mutually independent, which need not hold empirically. This paper proposes a new test for measuring independence of utility of life duration from quality of life in a riskless setting. We use a large representative sample of Dutch citizens and include two health states generally considered better than dead (BTD) and one health state considered worse than dead (WTD). Independence cannot be rejected when comparing the BTD health states, but is rejected when comparing the BTD states with the WTD state. In particular, utility of life duration becomes more concave for the WTD state. This may suggest that independence holds only for BTD health states. This has implications for the QALY model and would require using sign-dependent utility of life duration functions.
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Affiliation(s)
- Arthur E Attema
- iBMG/iMTA, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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Nord E, Enge AU, Gundersen V. QALYs: is the value of treatment proportional to the size of the health gain? HEALTH ECONOMICS 2010; 19:596-607. [PMID: 19459186 DOI: 10.1002/hec.1497] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In societal priority setting between health programs for different patient groups, many people are reluctant to discriminate too strongly between those who can benefit much from treatment and those who can benefit moderately. We suggest that this view of distributive fairness has a counterpart in personal valuations of gains in health. Such valuations may be influenced by psychological reference points and diminishing marginal utility such that the individual utility of care in patient groups with different potentials may be more similar than what conventional QALY estimates suggest. In interviews in three convenience samples, there is some support for the hypothesis. Most respondents do not think that desire for treatment is significantly less in those who stand to gain only moderately compared with those who stand to gain much - even when the treatment is associated with a mortality risk. When stating insurance preferences, a majority of subjects express a greater concern for avoiding the worst states in question than for maximising expected value for money in terms of treatment effects. The tendency applies to outcomes in terms of both quality and quantity of life. Choices between prefixed response options fit well with oral explanations of these choices.
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Affiliation(s)
- Erik Nord
- Norwegian Institute of Public Health, The University of Oslo, Oslo, Norway.
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Abellan-Perpiñan JM, Bleichrodt H, Pinto-Prades JL. The predictive validity of prospect theory versus expected utility in health utility measurement. JOURNAL OF HEALTH ECONOMICS 2009; 28:1039-1047. [PMID: 19833400 DOI: 10.1016/j.jhealeco.2009.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 07/23/2009] [Accepted: 09/10/2009] [Indexed: 05/28/2023]
Abstract
Most health care evaluations today still assume expected utility even though the descriptive deficiencies of expected utility are well known. Prospect theory is the dominant descriptive alternative for expected utility. This paper tests whether prospect theory leads to better health evaluations than expected utility. The approach is purely descriptive: we explore how simple measurements together with prospect theory and expected utility predict choices and rankings between more complex stimuli. For decisions involving risk prospect theory is significantly more consistent with rankings and choices than expected utility. This conclusion no longer holds when we use prospect theory utilities and expected utilities to predict intertemporal decisions. The latter finding cautions against the common assumption in health economics that health state utilities are transferable across decision contexts. Our results suggest that the standard gamble and algorithms based on, should not be used to value health.
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Reference-dependent preferences and loss aversion: A discrete choice experiment in the health-care sector. JUDGMENT AND DECISION MAKING 2008. [DOI: 10.1017/s1930297500001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractThis study employs a Discrete Choice Experiment (DCE) in the health-care sector to test the loss aversion theory that is derived from reference-dependent preferences: The absolute subjective value of a deviation from a reference point is generally greater when the deviation represents a loss than when the same-sized change is perceived as a gain. As far as is known, this paper is the first to use a DCE to test the loss aversion theory. A DCE is a highly suitable tool for such testing because it estimates the marginal valuations of attributes, based on deviations from a reference point (a constant scenario). Moreover, loss aversion can be examined for each attribute separately. Another advantage of a DCE is that is can be applied to non-traded goods with non-tangible attributes. A health-care event is used for empirical illustration: The loss aversion theory is tested within the context of preference structures for maternity-ward attributes, estimated using data gathered from 3850 observations made by a sample of 542 women who had recently given birth. Seven hypotheses are presented and tested. Overall, significant support for behavioral loss aversion theories was found.
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van Osch SMC, Stiggelbout AM. The construction of standard gamble utilities. HEALTH ECONOMICS 2008; 17:31-40. [PMID: 17410521 DOI: 10.1002/hec.1235] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Health effects for cost-effectiveness analysis are best measured in life years, with quality of life in each life year expressed in terms of utilities. The standard gamble (SG) has been the gold standard for utility measurement. However, the biases of probability weighting, loss aversion, and scale compatibility have an inconclusive effect on SG utilities. We determined their effect on SG utilities using qualitative data to assess the reference point and the focus of attention. While thinking aloud, 45 healthy respondents provided SG utilities for six rheumatoid arthritis health states. Reference points, goals, and focuses of attention were coded. To assess the effect of scale compatibility, correlations were assessed between focus of attention and mean utility. The certain outcome served most frequently as reference point, the SG was perceived as a mixed gamble. Goals were mostly mentioned with respect to this outcome. Scale compatibility led to a significant upward bias in utilities; attention lay relatively more on the low outcome and this was positively correlated with mean utility. SG utilities should be corrected for loss aversion and probability weighting with the mixed correction formula proposed by prospect theory. Scale compatibility will likely still bias SG utilities, calling for research on a correction.
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Affiliation(s)
- Sylvie M C van Osch
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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