Valuing health states: A comparison of methods

Department of Economics, University of Newcastle, Newcastle-Upon Tyne, UK.
Journal of Health Economics (Impact Factor: 2.58). 05/1996; 15(2):209-31. DOI: 10.1016/0167-6296(95)00038-0
Source: PubMed


In eliciting health state valuations, two widely used methods are the standard gamble (SG) and the time trade off (TTO). Both methods make assumptions about individual preferences that are too restrictive to allow them to act as perfect proxies for utility. Therefore, a choice between them might instead be made on empirical grounds. This paper reports on a study which compared a "props" (using specifically-designed boards) and a "no props" (using self-completion booklets) variant of each method. The results suggested that both non props variants might be susceptable to framing effects and that TTP props outperformed SG props.

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    • "However, both techniques have several shortcomings. First, they can be cognitively challenging (Patrick et al., 1994; Dolan et al., 1996) generating individual responses that are either logically inconsistent or otherwise difficult to accept at face value (e.g. all health states have the same value) (Craig and Ramachandran, 2006). "
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    ABSTRACT: There is interest in the use of discrete choice experiments that include a duration attribute (DCETTO) to generate health utility values, but questions remain on its feasibility in large health state descriptive systems. This study examines the stability of DCETTO to estimate health utility values from the five-level EQ-5D, an instrument with depicts 3125 different health states. Between January and March 2011, we administered 120 DCETTO tasks based on the five-level EQ-5D to a total of 1799 respondents in the UK (each completed 15 DCETTO tasks on-line). We compared models across different sample sizes and different total numbers of observations. We found the DCETTO coefficients were generally consistent, with high agreement between individual ordinal preferences and aggregate cardinal values. Keeping the DCE design and the total number of observations fixed, subsamples consisting of 10 tasks per respondent with an intermediate sized sample, and 15 tasks with a smaller sample provide similar results in comparison to the whole sample model. In conclusion, we find that the DCETTO is a feasible method for developing values for larger descriptive systems such as EQ-5D-5L, and find evidence supporting important design features for future valuation studies that use the DCETTO.
    Social Science & Medicine 05/2014; 114C(100):38-48. DOI:10.1016/j.socscimed.2014.05.026 · 2.89 Impact Factor
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    • "In the SG, lost health is measured by the level of risk that an individual is willing to take, and the utility is evaluated as a negative function of such risk. In the TTO utility is measured by the amount of life expectancy an individual is willing to lose, understanding the utility as a positive function around longevity (Dolan et al. 1996). These last two methods are the choice when validating one of the other mentioned methods is required. "
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    ABSTRACT: The purpose of this review is to do a discussion about the use of the HRQoL as a health measure of the populations that enable to analyze its potential use as a measure of development and efficiency of health systems. The principal use of the HRQoL is in health technologies economics evaluation; however this measure can be use in public health when need to know the health state of population. The WHO recognizes its potential use but its necessary to do a discussion about your difficulties for its application and restrictions for its use as a performance indicator for the health systems. The review show the different aspects about the use of HRQoL how a measure of efficiency ot the health system, each aspect identified in the literature is analyzed and discussed, developing the pros and cons of their possible use, especially when it comes as a cardinal measure. The analysis allows recognize that measuring HRQoL in countries could serve as a useful indicator, especially when it seeks to measure the level of health and disease, as do most of the indicators of current use. However, the methodological constraints that do not allow comparability between countries especially when you have large socioeconomic differences have yet to be resolved to allow comparison between different regions.
    SpringerPlus 12/2013; 2(1):664. DOI:10.1186/2193-1801-2-664
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    • "A visual analogue scale (VAS) has also been used to produce national value [22] sets, but this does not involve a trade-off. Dolan et al. [23] concluded that the TTO fared slightly better than SG in valuing EQ-5D. Since 1995, the majority of EQ-5D valuations have used the TTO as their preferred elicitation method. "
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    ABSTRACT: Economic evaluations to inform decisions about allocation of health resources are scarce in Low and Middle Income Countries, including in Sri Lanka. This is in part due to a lack of country-specific utility weights, which are necessary to derive appropriate Quality Adjusted Life Years. The EQ-5D-3L, a generic multi-attribute instrument (MAUI), is most widely used to measure and value health states in high income countries; nevertheless, the sensitivity of generic MAUIs has been criticised in some conditions such as cancer. This article describes a protocol to produce both a generic EQ-5D-3L and cancer specific EORTC-8D utility index in Sri Lanka. EQ-5D-3L and EORTC-8D health states will be valued using the Time Trade-Off technique, by a representative population sample (n?=?780 invited) identified using stratified multi-stage cluster sampling with probability proportionate to size method. Households will be randomly selected within 30 clusters across four districts; one adult (=18 years) within each household will be selected using the Kish grid method. Data will be collected via face-to-face interview, with a Time Trade-Off board employed as a visual aid. Of the 243 EQ-5D-3L and 81,290 EORTC-8D health states, 196 and 84 respectively will be directly valued. In EQ-5D-3L, all health states that combine level 3 on mobility with either level 1 on usual activities or self-care were excluded. Each participant will first complete the EQ-5D-3L, rank and value 14 EQ-5D-3L states (plus the worst health state and "immediate death"), and then rank and value seven EORTC-8D states (plus "immediate death"). Participant demographic and health characteristics will be also collected. Regression models will be fitted to estimate utility indices for EQ-5D-3L and EORTC-8D health states for Sri Lanka. The dependent variable will be the utility value. Different specifications of independent variables will be derived from the ordinal EQ-5D-3L to test for the best-fitting model. In Sri Lanka, a LMIC health state valuation will have to be carried out using face to face interview instead of online methods. The proposed study will provide the first country-specific health state valuations for Sri Lanka, and one of the first valuations to be completed in a South Asian Country.
    Health and Quality of Life Outcomes 08/2013; 11(1):149. DOI:10.1186/1477-7525-11-149 · 2.12 Impact Factor
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