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Sangubol M, Snidvongs K, Lawpoolsri S, Mongkolkul K, Kowatanamongkon P, Chitsuthipakorn W. Health Utility Score in Thai Patients with Chronic Rhinosinusitis: Pre- and Postoperative Analyses. Laryngoscope 2024; 134:2070-2076. [PMID: 37819654 DOI: 10.1002/lary.31108] [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: 05/22/2023] [Revised: 08/22/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Endoscopic sinus surgery (ESS) can increase the health utility score (HUS) of patients with chronic rhinosinusitis (CRS) who require the surgery. HUS varies depending on the geographical or living environment. HUS in CRS has never been evaluated in Thailand. The objective of this study was to evaluate the HUS of Thai patients with CRS before and after ESS through multiple approaches. METHODS Thai patients (age ≥ 18) with CRS scheduled for ESS were enrolled in this prospective study. The preoperative (baseline) demographics, 22-items sinonasal outcome test, endoscopic score, and CT score were recorded. The HUS was evaluated using four methods: the EuroQoL-5 Dimension-5 level (EQ-5D-5L), Visual Analog Scale (VAS), Standard gamble (SG), and Time trade-off (TTO); at baseline, three months and six months post-operation. RESULTS Data from 60 patients were analyzed. The mean baseline HUS scores by EQ-5D-5L, VAS, SG, and TTO were 0.75, 0.65, 0.79, and 0.85, respectively. The postoperative HUS significantly improved to 0.96, 0.91, 0.96, 0.97 at three months, and 0.97, 0.92, 0.97, and 0.98 at six months, respectively. ESS raised the HUS by 0.12-0.27 points. Among the four methods, VAS showed the lowest HUS at all time points. CONCLUSION The preoperative HUS in Thai patients with CRS generally increased to near-perfect values after the ESS. The increase in HUS reflecting the improved general quality of life, was demonstrated at three and up to six months after ESS. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2070-2076, 2024.
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Affiliation(s)
- Melissa Sangubol
- Center of Excellence in Otolaryngology-Head & Neck Surgery, Rajavithi Hospital, Bangkok, Thailand
| | - Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kittichai Mongkolkul
- Center of Excellence in Otolaryngology-Head & Neck Surgery, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
| | - Patlada Kowatanamongkon
- Center of Excellence in Otolaryngology-Head & Neck Surgery, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
| | - Wirach Chitsuthipakorn
- Center of Excellence in Otolaryngology-Head & Neck Surgery, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
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Comparing actuarial and subjective healthy life expectancy estimates: A cross-sectional survey among the general population in Hungary. PLoS One 2022; 17:e0264708. [PMID: 35271611 PMCID: PMC8912206 DOI: 10.1371/journal.pone.0264708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background Healthy life expectancy (HLE) is becoming an important indicator of population health. While actuarial estimates of HLE are frequently studied, there is scarcity of research on the subjective expectations of people about their HLE. The objective of this study is to compare actuarial and subjective HLE (sHLE) estimates in the ≥50-year-old Hungarian general population. Furthermore, we assessed subjective life expectancy (sLE) and explored determinants of the individual variance of sHLE and sLE. Methods We conducted a cross-sectional online survey in 2019. Subjective health expectations were measured at 60, 70, 80 and 90 years of age via the Global Activity Limitation Indicator (GALI). Point-estimates of sLE and background variables were also recorded. sHLE was estimated from GALI and sLE responses. Actuarial estimates of life expectancy (LE) and HLE for 2019 were provided by the Central Statistical Office of Hungary. Results Five hundred and four respondents (female 51.6%) were included. Mean (±SD) age was 63 (±7.5) years. Median LE (81.5 years, 95%CI 81.1–81.7) and sLE (82 years, 95%CI 80–85) were similar (p = 0.142), while median sHLE (66.8 years, 95%CI 65.5–68.3) was lower than HLE (72.7 years, 95%CI 82.4–82.9) by 5.9 years (p<0.001). Despite the greater median actuarial LE of women compared to men (p<0.001), we found no gender differences between the median sLE (p = 0.930), HLE (p = 0.417) and sHLE (p = 0.403) values. With less apparent gender differences among the predictors when compared to sLE, sHLE was mainly determined by self-perceived health, age and place of residence, while self-perceived health, close relatives’ longevity, social conditions, happiness and perceived lifestyle influenced sLE. Conclusions Along subjective life expectancy, subjective healthy life expectancy may be a feasible indicator and provide insights to individuals’ subjective expectations underlying the demographic estimates of the healthy life expectancy of the population.
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Lipman SA. Expect Nothing: The (Lack of) Influence of Subjective Life Expectancy on Valuation of Child Health States. FRONTIERS IN HEALTH SERVICES 2022; 2:803109. [PMID: 36925864 PMCID: PMC10012738 DOI: 10.3389/frhs.2022.803109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022]
Abstract
Objective Earlier research has shown that individuals' subjective life expectancy (SLE) affects health state valuation with time trade-off (TTO). Individuals with longer expected life durations are less willing to trade-off life duration, which yields higher utilities. In this article, the influence of SLE is explored in the valuation of EQ-5D-Y-3L with a proxy perspective, i.e., adults' valuation of health states considering the life of a 10-year-old child. As SLE for children is likely higher, this might explain earlier findings suggesting that individuals are less willing to trade-off years of life for children than for adults. Methods A total of 197 respondents were recruited to take part in digital TTO interviews, facilitated by trained interviewers. TTO interviews were implemented in accordance with the recommended protocol for the valuation of EQ-5D-Y-3L. Respondents valued 10 EQ-5D-Y-3L health states for a 10-year-old child, after which they were asked to report how old they themselves expected to become and also how old they expected a 10-year-old child to become. Results Generally, adult respondents reported higher SLE for children than for themselves. Neither SLE was systematically associated with the willingness to trade lifetime or the number of life years traded off in TTO tasks. This null-result was substantiated by regression analyses per health state. Conclusion The results of this study suggest that individuals' expectations about longevity are not associated with EQ-5D-Y-3L valuation. This lack of association is in contrast to earlier work and might be explained by the psychological distance introduced with proxy perspective valuation, or by the methodological differences with earlier work.
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Affiliation(s)
- Stefan A Lipman
- Department of Health Economics, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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Avidor S, Palgi Y, Solomon Z. The Moderating Role of Views of Aging in the Longitudinal Relationship Between Physical Health and Mental Distress. J Gerontol B Psychol Sci Soc Sci 2021; 76:871-880. [PMID: 33254236 DOI: 10.1093/geronb/gbaa212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Some degree of mental distress is commonly present in old age, and it is often exacerbated in later life following changes in physical health. This work presents in 2 studies among samples that have been exposed to stressful experiences in the past, a prospective examination of how the association between physical health and mental distress is attenuated by 2 forms of views on aging, evaluations of age, and evaluations of one's future. METHOD Study 1 (N = 226) was conducted in 2008 (Time 1) and 2014 (Time 2), among Israeli war veterans (mean age 64.90, SD = 5.04); Study 2 (N = 132) was conducted in 2014 (Time 1) and 2015 (Time 2) among older adults who were exposed to ongoing rocket fire in the south of Israel (mean age 66.44, SD = 9.77). Participants reported on their subjective age, subjective life expectancy (SLE [in Study 1]/distance to death [DtD; in Study 2]), health, and mental distress. RESULTS Both studies showed that after controlling for exposure to trauma and for Time 1 mental distress, Time 1 subjective age, but not SLE/DtD, moderated the association between Time 1 physical health and Time 2 mental distress. DISCUSSION Subjective age and SLE represent distinct features of views of aging. Subjective age may reflect perceptions of one's aging process, associated more directly with health-related outcomes over time. SLE reflects future, death-related perceptions, therefore perhaps less directly associated with such outcomes.
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Affiliation(s)
- Sharon Avidor
- Faculty of Social and Community Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Yuval Palgi
- Department of Gerontology, University of Haifa, Israel
| | - Zahava Solomon
- I-Core Research Center for Mass Trauma, The Bob Shappell School of Social Work, Tel-Aviv University, Israel
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Lipman SA, Reckers-Droog VT, Kreimeier S. Think of the Children: A Discussion of the Rationale for and Implications of the Perspective Used for EQ-5D-Y Health State Valuation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:976-982. [PMID: 34243841 DOI: 10.1016/j.jval.2021.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/17/2020] [Accepted: 01/25/2021] [Indexed: 05/20/2023]
Abstract
OBJECTIVES The recently published EQ-5D-Y valuation protocol prescribes the general public values EQ-5D-Y health states for a 10-year-old child. This child perspective differs from the individual perspective applied for valuation of adult EQ-5D instruments. This article discusses the rationale for and implications of applying a child perspective for EQ-5D-Y health state valuation. METHODS This article was informed by an exploration of the normative and empirical literature on health state valuation. We identified and summarized key discussion points in a narrative review. RESULTS Although valuing EQ-5D-Y health states from an individual perspective is feasible, it may be problematic for several reasons. The use of a child perspective implies that-rather than valuing one's own health-someone else's health is valued. This may require the projection of one's own beliefs, expectations, and preferences on others, which could change the decision processes underlying the elicited preferences. Furthermore, because preferences are obtained for a 10-year-old child, it is unclear if this given age as well as other (missing) information on the described child beneficiary (should) affect valuation of EQ-5D-Y health states. CONCLUSIONS The change from an individual to a child perspective in the valuation of EQ-5D-Y will likely lead to differences in utilities. This has implications for the estimation of incremental health-related quality-of-life gains in economic evaluations of health technologies for children and adolescents and therefore might affect reimbursement decisions. Further research is necessary for gaining insight into the extent to which this impact is normatively and empirically justified.
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Affiliation(s)
- Stefan A Lipman
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands.
| | - Vivian T Reckers-Droog
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - Simone Kreimeier
- Bielefeld University, School of Public Health, Department of Health Economics and Health Care Management, Bielefeld, Germany
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Ernstsson O, Burström K, Heintz E, Mølsted Alvesson H. Reporting and valuing one's own health: a think aloud study using EQ-5D-5L, EQ VAS and a time trade-off question among patients with a chronic condition. Health Qual Life Outcomes 2020; 18:388. [PMID: 33334348 PMCID: PMC7745504 DOI: 10.1186/s12955-020-01641-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background The EQ-5D-5L, the EQ VAS, and the time trade-off (TTO) are commonly used to report and value health. Still, there is a need to better understand how these questionnaires and methods are perceived by the respondents, as well as the thoughts and motives behind their responses. The aim of this study was to increase knowledge of how individuals think and reason when reporting and valuing their own current health, using EQ-5D-5L, EQ VAS, and an open-ended TTO question. Methods Twenty patients with type 1 diabetes participated in qualitative individual think aloud interviews in Stockholm, Sweden. Participants were asked to describe their thoughts when responding to three assessments. The interviews were transcribed verbatim and analyzed using thematic analysis. Results The analysis showed that participants conducted the assessments by contextualizing and interpreting instructions, relating the questions to their own health, using different recall periods and time perspectives, and using personal, interpersonal, or normative comparators. It was challenging to reduce the experience of everyday life into a response option, and the thoughts behind the responses differed between the assessments. Before deciding on what to include, participants thought of the purpose and context of the assessments. Current health or past experiences of health were applied in the EQ-5D descriptive system and in EQ VAS, while participants focused on the future in the TTO. Thoughts about the impact on others, personal goals, and expectations on future health were more clearly integrated in the TTO assessment. All participants considered the trade-off between life years and health. However, despite the use of different comparators, the concept of ‘full health’ was found difficult to imagine or relate to. Conclusions This study provides insights as to how responses to the EQ-5D-5L, EQ VAS, and TTO assessments are complementary and where these assessments differ in adults with a chronic condition. The findings may contribute to a better understanding when interpreting the quantitative results and contribute to the literature pertaining to possible explanations for differences in health state values depending on the valuation method.
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Affiliation(s)
- Olivia Ernstsson
- QRC Research Unit, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Health Care Services, Region Stockholm, 171 77, Stockholm, Sweden
| | - Emelie Heintz
- QRC Research Unit, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Helle Mølsted Alvesson
- Health Systems and Policy, Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
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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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Song HJ, Park H, Park SY, Lee EK, Ha SY, Park SY, Bae EJ, Ku H. Estimation of Health Utilities Based on the Response to Treatment in Atopic Dermatitis: a Population-based Study. Clin Ther 2019; 41:700-713. [PMID: 30827751 DOI: 10.1016/j.clinthera.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/19/2019] [Accepted: 02/10/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE This study estimated utility weights based on the response to treatment for atopic dermatitis in the general population. METHODS The Korean general population aged 20-60 years was stratified by using a random sampling method based on age and sex. Two hypothetical health states of atopic dermatitis were developed: response to treatment and no response to treatment. Health utility values were estimated by using time trade-off (TTO) based on a period of 10 years, TTO based on life expectancy, and EuroQol 5-Dimension (EQ-5D) including a visual analog scale (VAS). The mean utility value and 95% CI were derived, and comparisons of subgroups using the t test and ANOVA were performed. We conducted a multilevel analysis after controlling the sociodemographic variables to consider repeated measures. FINDINGS A total of 155 participants were included in the survey. Their mean age was 39.7 years; 58.7% of participants were women. The mean health utility values for response and no response using TTO based on 10 years were 0.847 and 0.380, respectively. The estimated health utility values of response and no response were 0.865 and 0.476 using TTO based on life expectancy, and 0.814 and 0.279 using EQ-5D. For VAS, the response and no response were 0.744 and 0.322. After controlling the covariates, the important factors that affected utility values were response and no response to treatment (P < 0.001). IMPLICATIONS This study showed that the utility weights of people with no response to atopic dermatitis treatment were lower compared with response from the general population. Health care providers should therefore consider symptom control as an important factor affecting the quality of life of those with atopic dermatitis.
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Affiliation(s)
- Hyun Jin Song
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | | | | | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - So-Young Ha
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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A note on the relationship between age and health-related quality of life assessment. Qual Life Res 2018; 28:1201-1205. [PMID: 30523567 PMCID: PMC6470117 DOI: 10.1007/s11136-018-2071-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To extend existing analyses of whether and how the age of respondents is related to their time trade-off (TTO) valuations of hypothetical EQ-5D-3L health states, and to contribute to the existing debate about the rationale and implications for using age-specific utilities in health technology assessment (HTA). METHODS We use data from the MVH UK valuation study. For each profile, the mean TTO value-adjusted by sex, education, self-reported health and personal experience of serious illness-is pairwise compared across the different age groups. A Bonferroni correction is applied to the multiple testing of significant differences between means. Smile plots illustrate the results. A debate regarding whether there is a case for using age-specific utilities in HTAs complements the analysis. RESULTS Results show that the oldest respondents value health profiles lower than younger age groups, particularly for profiles describing problems in the mobility dimension. CONCLUSION The findings raise the possibility of using age-specific value sets in HTAs, since a technology may not be cost-effective on average but cost-effective for a sub-group whose preferences are more closely aligned to the benefits offered by the technology.
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Jendle J, Sandberg A, Buchs S, Swinburn P, Hadi M, Levin LÅ. A utility valuation study assessing the impact of postprandial glucose control on quality of life of individuals with type 1 or type 2 diabetes. J Patient Rep Outcomes 2018; 2:20. [PMID: 29757323 PMCID: PMC5934930 DOI: 10.1186/s41687-018-0045-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 04/11/2018] [Indexed: 01/09/2023] Open
Abstract
Background Consideration of health-related quality of life (HRQOL) in diabetes has been associated with long-term and short-term complications such as hypoglycaemia, but not with short-term glucose control. This study aimed to collect health utilities related to different degrees of poorly controlled postprandial glucose (PPG) and its impact on HRQOL in the UK and in Sweden. Methods Three health state descriptions were developed based on literature reviews and interviews with people with diabetes and healthcare professionals, characterising mild, moderate and severe impact of postprandial hyperglycaemic symptoms on HRQOL. Time Trade-Off (TTO) interviews with a 10-year trade-off period were conducted with samples of the UK general public and of Swedish people with diabetes. Mean TTO-derived health state values were expressed on a scale from 0 (death) to 1 (full health). Results One hundred fifty participants from the general population were interviewed in the UK (57% female, mean age 35 years) and 150 participants with diabetes in Sweden (64% female, mean age 51 years, 42% type 1 and 58% type 2 diabetes). The mean TTO-derived health state values were for the UK and Swedish participants: mild impact of poorly PPG control (0.89/0.76); moderate (0.75/0.71); severe (0.56/0.58). Conclusions Glucose lowering treatments associated with improved control over PPG levels could have important benefits to people with type 1 and type 2 diabetes since findings suggest that increasing severity in postprandial hyperglycaemic symptoms is perceived as having significant negative impact on HRQOL of individuals with type 1 or type 2 diabetes.
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Affiliation(s)
- J Jendle
- 1Faculty of Medical Sciences, Örebro University, Örebro, Sweden
| | - A Sandberg
- 2Novo Nordisk A/S, Vandtårnsvej 114, DK-2860 Søborg, Denmark
| | - S Buchs
- 2Novo Nordisk A/S, Vandtårnsvej 114, DK-2860 Søborg, Denmark
| | - P Swinburn
- Patient-Centered Outcomes, Mapi, London, UK
| | - M Hadi
- Patient-Centered Outcomes, Mapi, London, UK
| | - L Å Levin
- 4Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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van Nooten FE, Houghton K, van Exel J, van Agthoven M, Brouwer WBF, Stull DE. A (Latent) Class of Their Own: Response Patterns in Trading Off Quantity and Quality of Life in Time Trade-Off Exercises. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1403-1410. [PMID: 29241900 DOI: 10.1016/j.jval.2017.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 06/02/2017] [Accepted: 06/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Conflicting results regarding associations of time trade-off (TTO) valuations with respondent characteristics have been reported, mostly on the basis of regression analyses. Alternative approaches, such as the latent class analysis (LCA), may add to the further understanding of variations in TTO responses. OBJECTIVES To identify whether subgroups of respondents can be identified on the basis of their responses to TTO exercises and to investigate which respondent characteristics are associated with membership of the identified subgroups. METHODS Members of the Dutch general public, aged 18 to 65 years, completed a Web-based questionnaire concerning sociodemographic characteristics, three TTO exercises valuing health states described using the domains of the EuroQol five-dimensional questionnaire, and preference for quality versus quantity of life. LCA was used to identify patterns in the responses. Predictive variables were included in the final LCA model to identify the particular respondent characteristics that predict subgroup membership. RESULTS The sample consisted of 1067 respondents. Four latent classes were identified in the responses to TTO exercises. Two were high traders, focusing on quality of life and trading off a relatively high number of years. The other two were low traders, focusing on length of life. Predictive analyses revealed significant differences between subgroups in terms of age, sex, subjective life expectancy, and preference for quantity over quality of life. CONCLUSIONS We showed that distinct classes of respondents can be discerned in TTO responses from the general public, distinguishing subgroups of low and high traders. More research in this area should confirm our findings and investigate their implications for health state valuation exercises.
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Affiliation(s)
- F E van Nooten
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - K Houghton
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - J van Exel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - M van Agthoven
- Pharmaceutical Companies of Johnson & Johnson, Breda, The Netherlands
| | - W B F Brouwer
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - D E Stull
- RTI Health Solutions, Research Triangle Park, NC, USA
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Palgi Y. Matter of will: The association between posttraumatic stress symptoms and the will-to-live. Psychiatry Res 2017; 249:180-186. [PMID: 28104565 DOI: 10.1016/j.psychres.2017.01.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/10/2016] [Accepted: 01/08/2017] [Indexed: 11/28/2022]
Abstract
The present study examined how posttraumatic-stress-symptoms presented after prolonged traumatic exposure to rocket attacks are related to the perception of the worthiness of life among individuals in the second half of their lives. Additionally, it was questioned whether the subjective evaluation of the time one has left to live affects this relationship. Using an in-region random digit dialing methodology, phone calls made to residents in the south of Israel, we sampled 339 community-dwelling older adults (age range 50-90; M=65.44, SD=9.77) in Wave 1, 170 of whom were interviewed again in Wave 2 about a year later. Participants completed a phone-questionnaire on posttraumatic-stress-symptoms, subjective nearness-to-death, and will-to-live. The cross-sectional and longitudinal analyses results showed that higher levels of posttraumatic-stress-symptoms were positively related to higher will-to-live in both waves, among individuals who felt further away from death, while higher levels of posttraumatic-stress-symptoms were negatively related or unrelated to lower will-to-live among those who felt close to death in Waves 1and 2, respectively. The findings emphasize that perceptions regarding one's future perspective may affect the quality of the relationship between posttraumatic-stress-symptoms and will-to-live. Theoretical and practical implications are discussed.
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Affiliation(s)
- Yuval Palgi
- Department of Gerontology, The Center for Research and Study of Aging, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa 3498838, Israel.
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Matza LS, Boye KS, Feeny DH, Bowman L, Johnston JA, Stewart KD, McDaniel K, Jordan J. The time horizon matters: results of an exploratory study varying the timeframe in time trade-off and standard gamble utility elicitation. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:979-990. [PMID: 26611792 PMCID: PMC5047932 DOI: 10.1007/s10198-015-0740-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/05/2015] [Indexed: 05/04/2023]
Abstract
INTRODUCTION The purpose of this study was to examine whether the time horizon of time trade-off (TTO) and standard gamble (SG) utility assessment influences utility scores and discrimination between health states. METHODS In two phases, UK general population participants rated three osteoarthritis health states in TTO and SG procedures with two time horizons: (1) 10-year and (2) a time horizon derived from self-reported additional life expectancy (ALE). The two time horizons were compared in terms of mean utilities and discrimination among health states. RESULTS In Phase 1, the 10-year tasks were completed by 80 participants, 35 of whom also completed utility assessment with the ALE. In Phase 2, all 101 participants completed procedures with both time horizons. Utility scores tended to be lower with the ALE than the 10-year, a difference that was statistically significant for two health states with SG in Phase 1 (P < 0.05), two health states with TTO in Phase 2 (P < 0.01), and one health state with SG in Phase 2 (P < 0.001). In Phase 1, rates of discrimination between mild and moderate osteoarthritis health states were significantly higher with the ALE than the 10-year (TTO: P = 0.03; SG: P = 0.001). This pattern of discrimination was similar in Phase 2. DISCUSSION Results suggest that the time horizon could influence utility scores and discrimination among health states. When designing utility evaluations, researchers should carefully consider the time horizon so that the value of health states is accurately represented in cost-utility models.
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Affiliation(s)
- Louis S Matza
- Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA.
| | | | - David H Feeny
- Department of Economics, McMaster University, Hamilton, ON, Canada
| | - Lee Bowman
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Katie D Stewart
- Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | - Kelly McDaniel
- Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | - Jessica Jordan
- Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
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Tilling C, Krol M, Attema AE, Tsuchiya A, Brazier J, van Exel J, Brouwer W. Exploring a new method for deriving the monetary value of a QALY. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:801-9. [PMID: 26289341 DOI: 10.1007/s10198-015-0722-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 08/05/2015] [Indexed: 05/07/2023]
Abstract
Several studies have sought to determine the monetary value of health gains expressed as quality adjusted life years (QALYs) gained, predominantly using willingness to pay approaches. However, willingness to pay has a number of recognized problems, most notably its insensitivity to scope. This paper presents an alternative approach to estimate the monetary value of a QALY, which is based on the time trade-off method. Moreover, it presents the results of an online study conducted in the Netherlands exploring the feasibility of this novel approach. The results seem promising, but also highlight a number of methodological problems with this approach, most notably nontrading and the elicitation of negative values. Additional research is necessary to try to overcome these problems and to determine the potential of this new approach.
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Affiliation(s)
- Carl Tilling
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Marieke Krol
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
- Department of Health Policy and Management, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Arthur E Attema
- Department of Health Policy and Management, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Aki Tsuchiya
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Department of Economics, University of Sheffield, Sheffield, UK
| | - John Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Job van Exel
- Department of Health Policy and Management, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Werner Brouwer
- Department of Health Policy and Management, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
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van Nooten FE, van Exel NJA, Eriksson D, Brouwer WBF. "Back to the future": Influence of beliefs regarding the future on TTO answers. Health Qual Life Outcomes 2016; 14:4. [PMID: 26753687 PMCID: PMC4709901 DOI: 10.1186/s12955-015-0402-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 12/23/2015] [Indexed: 11/25/2022] Open
Abstract
Background A common approach to obtain health state valuations is the time-tradeoff (TTO) method. Much remains unknown regarding the influence of responder characteristics on TTO answers. The objective of this study is to increase understanding of the influence that beliefs regarding future health and death, as well as desires to witness certain life events, have on respondents’ health state valuations. Methods An online survey was designed, including three TTO questions using a 10 year timeframe. Moreover, respondents completed demographic questions, the Health-Risk Attitude Scale (HRAS), the Expectations Regarding Aging (ERA) questionnaire, questions about beliefs regarding future health (i.e. life expectancy) and death (i.e. fear of death, belief in life after death and opinion about euthanasia), and about important life events taking place within the TTO timeframe. Regression analyses were performed in order to assess the influence of these different variables. Results One thousand sixty-seven respondents were included in the analyses. The following variables were significantly associated with years traded off: ERA mental health (decrease), ERA physical health (increase), HRAS (increase), support for euthanasia (increase), fear of death (decrease) and consideration of an important life event (decrease). The explained variance of the final model was low (0.08). Conclusion TTO responses may be influenced by considerations of future health, including life events and attitudes regarding health risks and death. Further investigation of TTO responses remains warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0402-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F E van Nooten
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - N J A van Exel
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | | | - W B F Brouwer
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. .,Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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van Nooten FE, van Exel NJA, Koolman X, Brouwer WBF. "Married with children" the influence of significant others in TTO exercises. Health Qual Life Outcomes 2015; 13:94. [PMID: 26135391 PMCID: PMC4487600 DOI: 10.1186/s12955-015-0276-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 05/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background Which responder characteristics influence TTO scores remains underexplored. More research is needed in order to understand (differences in) TTO scores, but also in the context of generating representative health state valuations for some population. Previous studies have found age, gender, marital status and subjective life expectancy to influence the number of years traded off. Objective This study aimed to investigate which other responder characteristics influence TTO responses, with an emphasis on consideration of significant others, such as partners and children. Methods and Design We performed a web-based survey in a representative sample of the Dutch general public (aged 18–65). Data on demographics, health status and expectations about future length and quality of life were gathered. Respondents valued three distinct health states using TTO. Results A total of 1067 respondents completed the questionnaire. Sixty percent of respondents had children and 49 % were married. The mean number of years traded off increased with severity of health states. Higher age and living together were positively associated with number of years traded off. Increases in subjective life expectancy, having children and being male (were negatively associated with the number of years traded-off. Conclusion Age, gender and subjective life expectancy, living together and having children were significantly associated with TTO responses. Consideration of significant others in TTO exercises thus may be important in understanding (differences in) TTO responses and when drawing representative samples from the general public. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0276-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F E van Nooten
- Institute of Health Policy & Management (iBMG) and Institute of Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - N J A van Exel
- Institute of Health Policy & Management (iBMG) and Institute of Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - X Koolman
- Department of Health Sciences, VU Amsterdam, Amsterdam, The Netherlands
| | - W B F Brouwer
- Institute of Health Policy & Management (iBMG) and Institute of Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands. .,iBMG/iMTA, Erasmus University Rotterdam, PO Box 1738, 3000DR, Rotterdam, The Netherlands.
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Pinto-Prades JL, Rodríguez-Míguez E. The lead time tradeoff: the case of health states better than dead. Med Decis Making 2014; 35:305-15. [PMID: 25009190 DOI: 10.1177/0272989x14541952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lead time tradeoff (L-TTO) is a variant of the time tradeoff (TTO). L-TTO introduces a lead period in full health before illness onset, avoiding the need to use 2 different procedures for states better and worse than dead. To estimate utilities, additive separability is assumed. We tested to what extent violations of this assumption can bias utilities estimated with L-TTO. METHODS A sample of 500 members of the Spanish general population evaluated 24 health states, using face-to-face interviews. A total of 188 subjects were interviewed with L-TTO and the rest with TTO. Both samples evaluated the same set of 24 health states, divided into 4 groups with 6 health states per set. Each subject evaluated 1 of the sets. A random effects regression model was fitted to our data. Only health states better than dead were included in the regression since it is in this subset where additive separability can be tested clearly. RESULTS Utilities were higher in L-TTO in relation to TTO (on average L-TTO adds about 0.2 points to the utility of health states), suggesting that additive separability is violated. The difference between methods increased with the severity of the health state. Thus, L-TTO adds about 0.14 points to the average utility of the less severe states, 0.23 to the intermediate states, and 0.28 points to the more severe estates. CONCLUSIONS L-TTO produced higher utilities than TTO. Health problems are perceived as less severe if a lead period in full health is added upfront, implying that there are interactions between disjointed time periods. The advantages of this method have to be compared with the cost of modeling the interaction between periods.
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Thirty down, only ten to go?! Awareness and influence of a 10-year time frame in TTO. Qual Life Res 2013; 23:377-84. [DOI: 10.1007/s11136-013-0495-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
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Attema AE, Edelaar-Peeters Y, Versteegh MM, Stolk EA. Time trade-off: one methodology, different methods. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14 Suppl 1:S53-64. [PMID: 23900665 PMCID: PMC3728453 DOI: 10.1007/s10198-013-0508-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
There is no scientific consensus on the optimal specification of the time trade-off (TTO) task. As a consequence, studies using TTO to value health states may share the core element of trading length of life for quality of life, but can differ considerably on many other elements. While this pluriformity in specifications advances the understanding of TTO from a methodological point of view, it also results in incomparable health state values. Health state values are applied in health technology assessments, and in that context comparability of information is desired. In this article, we discuss several alternative specifications of TTO presented in the literature. The defining elements of these specifications are identified as being either methodological, procedural or analytical in nature. Where possible, it is indicated how these elements affect health state values (i.e., upward or downward). Finally, a checklist for TTO studies is presented, which incorporates a list of choices to be made by researchers who wish to perform a TTO task. Such a checklist enables other researchers to align methodologies in order to enhance the comparability of health state values.
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Affiliation(s)
- Arthur E Attema
- iBMG/iMTA, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
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