scholarly journals Influence of elicitation procedure and phrasing on health state valuations in experience-based time trade-off tasks among diabetes patients in China

2019 ◽  
Vol 29 (1) ◽  
pp. 289-301
Author(s):  
Shuang Hao ◽  
Emelie Heintz ◽  
Gert Helgesson ◽  
Sophie Langenskiöld ◽  
Jiaying Chen ◽  
...  
Keyword(s):  
Visual Presentation ◽  
Health State ◽  
Chinese Adults ◽  
Health States ◽  
Trade Off ◽  
Face To Face ◽  
Health State Valuations ◽  
The Difference ◽  
Elicitation Procedure

Abstract Purpose Open-ended and iteration-based time trade-off (TTO) tasks can both be used for valuation of health states. It has so far not been examined how the elicitation procedure affects the valuation of experience-based health states. The purpose of this study is to investigate the influence of elicitation procedure on experience-based health state values elicited by the TTO method. Methods 156 Chinese adults with type 2 diabetes participated in face-to-face interviews with an open-ended or an iteration-based TTO task. The association between the type of TTO task and the valuation of health states was investigated through multiple linear regression analyses. A modified open-ended TTO task was also developed (n = 33) to test whether different phrasings of open-ended TTO tasks influence TTO values. Results Higher TTO values were observed in the original open-ended TTO task compared to the iteration-based task, which indicates that the elicitation procedure influences the valuation of health states. When the modified open-ended task was introduced, the difference between the two elicitation procedures was no longer statistically significant, suggesting that the phrasing and/or visual presentation of the TTO task may influence the valuation of health states. Conclusions The choice of elicitation procedure as well as the description of experience-based TTO tasks may influence the valuation of health states. Further research is warranted, also in other cultural contexts, to further explore these findings.

scholarly journals Comparison of online and face-to-face valuation of the EQ-5D-5L using composite time trade-off

2020 ◽  
Author(s):  
Ruixuan Jiang ◽  
James Shaw ◽  
Axel Mühlbacher ◽  
Todd A. Lee ◽  
Surrey Walton ◽  
...  
Keyword(s):  
Task Engagement ◽  
Health State ◽  
Health States ◽  
Trade Off ◽  
Face To Face ◽  
Random Intercept ◽  
Trade Offs ◽  
Trading Patterns ◽  
Value Sets ◽  
Better Than

Abstract Objective The aim of this study was to compare online, unsupervised and face-to-face (F2F), supervised valuation of EQ-5D-5L health states using composite time trade-off (cTTO) tasks. Methods The official EuroQol experimental design and valuation protocol for the EQ-5D-5L of 86 health states were implemented in interviewer-assisted, F2F and unsupervised, online studies. Validity of preferences was assessed using prevalence of inconsistent valuations and expected patterns of TTO values. Respondent task engagement was measured using number of trade-offs and time per task. Trading patterns such as better-than-dead only was compared between modes. Value sets were generated using linear regression with a random intercept (RILR). Value set characteristics such as range of scale and dimension ranking were evaluated between modes. Results Five hundred one online and 1,134 F2F respondents completed the surveys. Mean elicited TTO values were higher online than F2F when compared by health state severity. Compared to F2F, a larger proportion of online respondents did not assign the poorest EQ-5D-5L health state (i.e., 55555) the lowest TTO value ([Online] 41.3% [F2F] 12.2%) (p < 0.001). A higher percentage of online cTTO tasks were completed in 3 trade-offs or fewer ([Online] 15.8% [F2F] 3.7%), (p < 0.001). When modeled using the RILR, the F2F range of scale was larger than online ([Online] 0.600 [F2F] 1.307) and the respective dimension rankings differed. Conclusions Compared to F2F data, TTO tasks conducted online had more inconsistencies and decreased engagement, which contributed to compromised data quality. This study illustrates the challenges of conducting online valuation studies using the TTO approach.

Do individuals consider expected income when valuing health states?

2008 ◽  
Vol 24 (04) ◽  
pp. 488-494 ◽  
Author(s):  
Thomas Davidson ◽  
Lars-Åke Levin
Keyword(s):  
Cost Effectiveness ◽  
Analogue Scale ◽  
Income Group ◽  
The Other ◽  
Health State ◽  
Health States ◽  
Trade Off ◽  
Productivity Costs ◽  
Effectiveness Analysis ◽  
Health State Valuations

Objectives:The purpose of this study was to empirically explore whether individuals take their expected income into consideration when directly valuing predefined health states. This was intended to help determine how to handle productivity costs due to morbidity in a cost-effectiveness analysis.Methods:Two hundred students each valued four hypothetical health states by using time trade-off (TTO) and a visual analogue scale (VAS). The students were randomly assigned to two groups. One group was simply asked, without mentioning income, to value the different health states (the non-income group). The other group was explicitly asked to consider their expected income in relation to the health states in their valuations (the income group).Results:For health states that are usually assumed to have a large effect on income, the valuations made by the income group seemed to be lower than the valuations made by the non-income group. Among the students in the non-income group, 96 percent stated that they had not thought about their expected income when they valued the health states. In the income group, 40 percent believed that their expected income had affected their valuations of the health states.Conclusion:The results show that, as long as income is not mentioned, most individuals do not seem to consider their expected income when they value health states. This indicates that productivity costs due to morbidity are not captured within individuals' health state valuations. These findings, therefore, suggest that productivity costs due to morbidity should be included as a cost in cost-effectiveness analyses.

Estimating Utility Values for Health States of DFU Patients Using EQ-5D-5L and cTTO

2021 ◽  
pp. 153473462110143
Author(s):  
Morteza Arab-Zozani ◽  
Hossein Safari ◽  
Zoha Dori ◽  
Somayeh Afshari ◽  
Hosein Ameri ◽  
...  
Keyword(s):  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Economic Modeling ◽  
Health State ◽  
Health States ◽  
Utility Values ◽  
The Mean ◽  
The Difference ◽  
Diabetes Center ◽  
Health State Utility Values

Health-state utility values of diabetic foot ulcer (DFU) patients are necessary for clinical praxis and economic modeling. The purpose of this study was to estimate utility values in DFU patients using the EuroQol-5-dimension-5-level (EQ-5D-5L) and composite time trade-off (cTTO). The EQ-5D-5L and cTTO were used for estimating utility values. Data were collected from 228 patients referred to the largest governmental diabetes center in the South of Iran, Yazd province. When appropriate, independent sample t-test or analysis of variance test was used to test the difference in the utility values in each of the demographic and clinical characteristics of the patients. Finally, the BetaMix was used to identify predictors of the utility values. The means of EQ-5D-5L and cTTO values were 0.55( SD 0.21) and 0.67( SD 0.23), respectively. Anxiety and pain were the most common problems reported by the patients. The difference between the mean EQ-5D-5L values was significant for age, grade of ulcer, number of comorbidities, and having complications. In addition, variables of gender, age, grade of ulcer, and having complications were significant predictors of the EQ-5D-5L. The difference between the mean cTTO values was significant for age, employment status, grade of ulcer, number of comorbidities, and having complications. Moreover, variables of gender, age, grade of ulcer, number of comorbidities, and developing complications were significant predictors of cTTO. The current study provided estimates of utility values for DFU patients for clinical praxis and economic modeling. These estimates, similar to utilities reported in other studies, were low. Identifying strategies to decrease anxiety/depression and pain in patients is important to improve the utility values.

Treatment of venous thromboembolism with vitamin K antagonists: patients’ health state valuations and treatment preferences

2004 ◽  
Vol 92 (12) ◽  
pp. 1336-1341 ◽  
Author(s):  
Patrick Bossuyt ◽  
Peep Stalmeier ◽  
Mirjam Sprangers ◽  
Carlo van Dongen ◽  
Saskia Middeldorp ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Patient Characteristics ◽  
Haemorrhagic Stroke ◽  
Treatment Preferences ◽  
Health State ◽  
Health States ◽  
Health State Valuations ◽  
Cessation Of Treatment

SummaryDetermining the optimal duration of vitamin K antagonist (VKA) therapy for patients with venous thromboembolism (VTE) requires a weighting of the benefits and risks of treatment. The objectives of our study were to investigate patient variability in health state valuations associated with VKA therapy and treatment preferences, and to investigate the extent to which valuations and treatment preferences are associated with prior experience with these health states and other patient characteristics. Valuations of outcomes after VTE scaled from 0 (tantamount to death) to 1 (tantamount to perfect health) were elicited from 53 patients who had experienced VTE, 23 patients who had experienced major bleeding during treatment, and 48 patients with the post-thrombotic syndrome. In addition, patients’ treatment preferences were evaluated using treatment trade-off questions. Median health state valuations ranged from 0.33 for ‘non-fatal haemorrhagic stroke’ to 0.96 for ‘no VKA treatment’. Variability between patients was substantial. Patients’ treatment preferences also varied: 25% of patients chose cessation of treatment, regardless of the probability of recurrent VTE presented, whereas 23% of patients were never willing to choose cessation of treatment. Differences in valuations and treatment preferences were not associated with type of event experienced. Due to the substantial and unpredictable variability in valuations and treatment preferences, recommendations regarding treatment duration should be tailored to patients’ specific values and concerns.

scholarly journals Manipulating the 5 Dimensions of the EuroQol Instrument: The Effects on Self-Reporting Actual Health and Valuing Hypothetical Health States

2019 ◽  
Vol 39 (4) ◽  
pp. 380-392 ◽  
Author(s):  
Aki Tsuchiya ◽  
Nick Bansback ◽  
Arne Risa Hole ◽  
Brendan Mulhern
Keyword(s):  
Discrete Choice ◽  
Online Survey ◽  
Self Report ◽  
Discrete Choice Experiments ◽  
Health State ◽  
Health States ◽  
Different Types ◽  
Health State Valuations ◽  
The Uk ◽  
Actual Health

Background. The EQ-5D instrument has 5 dimensions. This article reports on the effects of manipulating a) the order in which the 5 dimensions are presented (appearing first v. last), b) splitting of the composite dimensions (“pain or discomfort” and “anxiety or depression”), and c) removing or “bolting off” 1 of the 5 EQ-5D dimensions at a time. The effects were examined in 2 contexts: 1) self-reporting health and 2) health state valuations. Methods. Three different types of discrete choice experiments (DCE) including a duration attribute were designed. An online survey with 12 subtypes, each with 10 DCE tasks, was designed and completed by 2494 members of the UK general public. Results. Of the 3 manipulations in the self-reporting context, only b) splitting anxiety or depression had a significant effect. In the health state valuation context, b) splitting level 5 pain or discomfort (relative to pain) and splitting level 5 anxiety or depression (relative to anxiety) had significant effects as did c) bolting off dimensions. Conclusions. We find that the values given to certain health dimensions are sensitive to the way in which it is described and the other health dimensions presented. Of particular interest is the effect of splitting composite dimensions: a given EQ-5D(-5L) profile may mean different things depending on whether the profile is used to self-report one’s health or to value hypothetical states, so that the health state values of EQ-5D(-5L) in population tariffs may not correspond to the states that patients self-report themselves in.

scholarly journals Conducting a Time Trade-Off Study Alongside a Clinical Trial: A Case Study and Recommendations

2018 ◽  
Vol 3 (1) ◽  
pp. 5-20 ◽  
Author(s):  
Jing Shen ◽  
Sarah Hill ◽  
David Mott ◽  
Matthew Breckons ◽  
Luke Vale ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Health State ◽  
Health States ◽  
Trade Off ◽  
Life Years ◽  
Related Quality ◽  
Health Related ◽  
Health State Utilities

Abstract Time trade-off (TTO) is an established method in health economics to elicit and value individuals’ preferences for different health states. These preferences are expressed in the form of health-state utilities that are typically used to measure health-related quality of life and calculate quality-adjusted life-years in an economic evaluation. The TTO approach to directly elicit health-state utilities is particularly valuable when generic instruments (e.g. EQ-5D) may not fully capture changes in utility in a clinical trial. However, there is limited guidance on how a TTO study should be conducted alongside a clinical trial despite it being a valuable tool. We present an account of the design and development of a TTO study within a clinical trial as a case study. We describe the development of materials needed for the TTO interviews, the piloting of the TTO materials and interview process, and recommendations for future TTO studies. This paper provides a practical guide and reference for future applications of the TTO method alongside a clinical trial.

Aggregating Health State Valuations

1997 ◽  
Vol 2 (3) ◽  
pp. 160-165 ◽  
Author(s):  
Paul Dolan
Keyword(s):  
Ethical Issues ◽  
Health State ◽  
Health States ◽  
Mean Values ◽  
Descriptive System ◽  
Health State Valuations ◽  
The Mean ◽  
Allocation Decisions ◽  
Priorities In Health Care ◽  
Resource Allocation Decisions

It is now recognized that preference-based measures of health status have an important role to play in determining priorities in health care. A number of methodological and ethical issues have been raised, but one that has as yet received little attention is the question of how individual responses should be aggregated when attempting to express the valuations of a given group. In a recent study of over 3000 members of the British general public, valuations were elicited for health states defined in terms of the EuroQol Descriptive System using the time trade-off method. A EuroQol ‘tariff’ of valuations has been generated which, because of the methodology employed, provides a good approximation of mean values. The purpose of this paper is to present a tariff based on median values. The nature of the distributions of values results in a median-based tariff which, compared to the mean-based one, has higher values for less severe states and lower values for more severe states. This is likely to have important implications for resource allocation decisions.

Surrogate inaccuracy in predicting older adults’ desire for life-sustaining interventions in the event of decisional incapacity: is it due in part to erroneous quality-of-life assessments?

2017 ◽  
Vol 29 (7) ◽  
pp. 1061-1068 ◽  
Author(s):  
Gina Bravo ◽  
Modou Sene ◽  
Marcel Arcand
Keyword(s):  
Quality Of Life ◽  
Older Adult ◽  
Rating Scales ◽  
Family Members ◽  
Community Dwelling ◽  
Health State ◽  
Health States ◽  
Registration Number ◽  
The Difference

ABSTRACTBackground:Family members are often called upon to make decisions for an incapacitated relative. Yet they have difficulty predicting a loved one's desire to receive treatments in hypothetical situations. We tested the hypothesis that this difficulty could in part be explained by discrepant quality-of-life assessments.Methods:The data come from 235 community-dwelling adults aged 70 years and over who rated their quality of life and desire for specified interventions in four health states (current state, mild to moderate stroke, incurable brain cancer, and severe dementia). All ratings were made on Likert-type scales. Using identical rating scales, a surrogate chosen by the older adult was asked to predict the latter's responses. Linear mixed models were fitted to determine whether differences in quality-of-life ratings between the older adult and surrogate were associated with surrogates’ inaccuracy in predicting desire for treatment.Results:The difference in quality-of-life ratings was a significant predictor of prediction inaccuracy for the three hypothetical health states (p < 0.01) and nearly significant for the current health state (p = 0.077). All regression coefficients were negative, implying that the more the surrogate overestimated quality of life compared to the older adult, the more he or she overestimated the older adult's desire to be treated.Conclusion:Discrepant quality-of-life ratings are associated with surrogates’ difficulty in predicting desire for life-sustaining interventions in hypothetical situations. This finding underscores the importance of discussing anticipated quality of life in states of cognitive decline, to better prepare family members for making difficult decisions for their loved ones.Trial Registration number:ISRCTN89993391

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