A Shortcut to Mean-Based Time Tradeoff Tariffs for the EQ-5D?

ArticleinMedical Decision Making 32(4):569-77 · January 2012with15 Reads
DOI: 10.1177/0272989X11431607 · Source: PubMed
EQ-5D valuation studies are usually performed using the time tradeoff (TTO) method, which is costly and time consuming. We focused on 2 properties that particularly characterize TTO: the initial choice task categorizing health states as better than death (BTD), worse than death (WTD), or equal to death (ETD), and unwillingness to trade (UTT) lifetime to improve health. The aim of this study was to estimate the value of the information to be gained from continuing the conventional TTO tasks beyond the initial question and the extent to which mean-based EQ-5D tariff values could be predicted through a simplified method of categorizing health states into BTD, WTD, ETD, and UTT. We used data from the UK EQ-5D valuation study (n = 2997). We designed an abbreviated system with only 4 values (collapsed TTO [cTTO]) based on the 4 response categories and assigned values as follows: WTD = -.5, ETD = 0, BTD = .5, and UTT = 1. Based on the mean cTTO scores for the valued health states, we created a regression-based cTTO tariff, which was compared with the conventional (full) TTO tariff (fTTO) by regressing 1) the fTTO means on cTTO means and 2) the fTTO tariff on the cTTO tariff. WTD values were unrelated to health state severity. Correlation between the means of fTTO and means of cTTO was >.999, and tariff values from fTTO correlated with tariff values from cTTO at r > .999. Once respondents have classified health states as UTT, BTD, ETD, or WTD, the TTO procedure adds little further information to the tariff values. The WTD task fails to discriminate between good and bad health states. TTO valuation could likely be simplified using cTTO.
    • "While there is little doubt that changing the routing procedure has substantial impact on elicited values, factors other than classical anchoring may be at play. For instance, respondents in the TTO group may react to the initial direct comparison to immediate death [27, 28]. It remains to be determined whether the observed anchoring effects are specific to TTO or whether the findings generalize to other iterative search-based indifference procedures, such as the standard gamble. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: The de facto standard method for valuing EQ-5D health states is the time trade-off (TTO), an iterative choice procedure. The TTO requires a starting point (SP), an initial offer of time in full health which is compared to a fixed offer of time in impaired health. From the SP, the time in full health is manipulated until preferential indifference. The SP is arbitrary, but may influence respondents, an effect known as anchoring bias. The aim of the study was to explore the potential anchoring effect and its magnitude in TTO experiments. Methods: A total of 1249 respondents valued 8 EQ-5D health states in a Web study. We used the lead time TTO (LT-TTO) which allows eliciting negative and positive values with a uniform method. Respondents were randomized to 11 different SPs. Anchoring bias was assessed using OLS regression with SP as the independent variable. In a secondary experiment, we compared two different SPs in the UK EQ-5D valuation study TTO protocol. Results: A 1-year increase in the SP, corresponding to an increase in TTO value of 0.1, resulted in 0.02 higher recorded LT-TTO value. SP had little impact on the relative distance and ordering of the eight health states. Results were similar to the secondary experiment. Conclusion: The anchoring effect may bias TTO values. In this Web-based valuation study, the observed anchoring effect was substantial. Further studies are needed to determine whether the effect is present in face-to-face experiments.
    Full-text · Article · Mar 2016
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose: Health state values are by convention anchored to 'perfect health' and 'death.' Attitudes toward death may consequently influence the valuations. We used attitudes toward euthanasia (ATE) as a sub-construct for attitudes toward death. We compared the influence on values elicited with time trade-off (TTO), lead-time TTO (LT-TTO) and visual analogue scale (VAS).Since the 'death' anchor is most explicit in TTO, we hypothesized that TTO values would be most influenced by ATE. Methods: Respondents valued eight EQ-5D health states with VAS, then TTO (n = 328) or LT-TTO (n = 484). We measured ATE on a scale from -2 (fully disagree) to 2 (fully agree) and used multiple linear regressions to predict VAS, TTO, and LT-TTO values by ATE, sex, age, and education. Results: A one-point increase on the ATE scale predicted a mean TTO value change of -.113 and LT-TTO change of -.072. Demographic variables, but not ATE, predicted VAS values. Conclusions: TTO appears to measure ATE in addition to preferences for health states. Different ways of incorporating death in the valuation may impact substantially on the resulting values. 'Death' is a metaphysically unknown concept, and implications of attitudes toward death should be investigated further to evaluate the appropriateness of using 'death' as an anchor.
    Article · Jun 2012
  • [Show abstract] [Hide abstract] ABSTRACT: The expected utility framework underlies much research in medical decision making. Because the framework requires decisions to be decomposed into probabilities of states and the values of those states, researchers have investigated the two components separately from each other and from patients' actual decisions. The authors propose that it would be productive to focus more research on the relationships among risk perceptions, outcome valuations, and choices in the same decision makers. They outline exploratory analyses based on two existing national surveys, the Medical Expenditure Panel Survey and the Joint Canada/United States Survey of Health.
    Article · Jun 2012
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