Do individuals consider expected income when valuing health states?

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.

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Mapping visual analogue scale health state valuations onto standard gamble and time trade-off values

Social Science & Medicine ◽

10.1016/s0277-9536(96)00271-7 ◽

1997 ◽

Vol 44 (10) ◽

pp. 1519-1530 ◽

Cited By ~ 69

Author(s):

Paul Dolan ◽

Matthew Sutton

Keyword(s):

Visual Analogue Scale ◽

Analogue Scale ◽

Standard Gamble ◽

Health State ◽

Trade Off ◽

Health State Valuations

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

Quality of Life Research ◽

10.1007/s11136-019-02292-9 ◽

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.

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Ixazomib (IXA), carfilzomib (CAR), elotuzumab (ELO) or daratumumab (DAR) with lenalidomide and dexamethasone (LEN+DEX) versus LEN+DEX only in relapsed/refractory multiple myeloma (R/R MM): A comparative cost-effectiveness analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.8043 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 8043-8043

Author(s):

Mavis Obeng-Kusi ◽

Daniel Arku ◽

Neda Alrawashdh ◽

Briana Choi ◽

Nimer S. Alkhatib ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Cost Utility ◽

Cost Effectiveness Analysis ◽

The Other ◽

Sensitivity Analyses ◽

Treatment Comparison ◽

Comparative Cost ◽

Effectiveness Analysis ◽

Life Years

8043 Background: IXA, CAR, ELO and DARin combination with LEN+DEXhave been found superior in efficacy compared to LEN+DEX in the management of R/R MM. Applying indirect treatment comparisons from a network meta-analysis (NMA), this economic evaluation aimed to estimate the comparative cost-effectiveness and cost-utility of these four triplet regimens in terms of progression-free survival (PFS). Methods: In the absence of direct treatment comparison from a single clinical trial, NMA was used to indirectly estimate the comparative PFS benefit of each regimen. A 2-state Markov model simulating the health outcomes and costs was used to evaluate PFS life years (LY) and quality-adjusted life years (QALY) with the triplet regimens over LEN+DEX and expressed as the incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR). Probability sensitivity analyses were conducted to assess the influence of parameter uncertainty on the model. Results: The NMA revealed that DAR+LEN+DEX was superior to the other triplet therapies, which did not differ statistically amongst them. As detailed in the Table, in our cost-effectiveness analysis, all 4 triplet regimens were associated with increased PFSLY and PFSQALY gained (g) over LEN+DEX at an additional cost. DAR+LEN+DEX emerged the most cost-effective with ICER and ICUR of $667,652/PFSLYg and $813,322/PFSQALYg, respectively. The highest probability of cost-effectiveness occurred at a willingness-to-pay threshold of $1,040,000/QALYg. Conclusions: Our economic analysis shows that all the triplet regimens were more expensive than LEN +DEX only but were also more effective with respect to PFSLY and PFSQALY gained. Relative to the other regimens, the daratumumab regimen was the most cost-effective.[Table: see text]

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Practical Aspects of Propulsion Shaft Alignment

10.5957/some-2021-012 ◽

2021 ◽

Author(s):

Kyriakos Avgouleas ◽

Emmanouil Sarris ◽

George Gougoulidis

Keyword(s):

Cost Effectiveness ◽

Numerical Model ◽

High Speed ◽

The Other ◽

Technical Literature ◽

Trade Off ◽

Fea Model ◽

Shaft Alignment ◽

Alignment Strategy ◽

Potential Damage

The economical and operational implications of poor alignment are indisputable for the propulsion shafting system of a commercial vessel. This holds true for naval vessels as well, although far less documented in the technical literature. This paper addresses some of the challenges associated with the proper alignment of a high-speed naval craft, which has been in service for many years. Laser bore-sighting was performed on a Guided Missile Fast Patrol Boat resting on a docking cradle. The measured bearing offsets were input to a FEA model of the shafting system to calculate bearing reactions and detect potential misalignment issues. Subsequent decisions regarding corrective measures take into account the results computed by the numerical model, experience from sister ships, the available documentation from the building yard and several other factors which are discussed in the paper. The solutions proposed are targeted towards a balanced trade-off between cost effectiveness and out-of-service time on one hand, and the risk of potential damage from misalignment on the other hand, which would seriously disrupt the ship’s operational availability. Practical aspects and lessons identified in the process are also presented, which demonstrate the distinct differences in alignment strategy of a high-speed naval craft compared to a typical commercial vessel.

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Valuing Health States for Use in Cost-Effectiveness Analysis

PharmacoEconomics ◽

10.2165/00019053-200826090-00007 ◽

2008 ◽

Vol 26 (9) ◽

pp. 769-779 ◽

Cited By ~ 59

Author(s):

John Brazier

Keyword(s):

Cost Effectiveness ◽

Cost Effectiveness Analysis ◽

Health States ◽

Effectiveness Analysis

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Self vs. other, child vs. adult. An experimental comparison of valuation perspectives for valuation of EQ-5D-Y-3L health states

The European Journal of Health Economics ◽

10.1007/s10198-021-01377-y ◽

2021 ◽

Author(s):

S. A. Lipman ◽

V. T. Reckers-Droog ◽

M. Karimi ◽

M. Jakubczyk ◽

A. E. Attema

Keyword(s):

Child Health ◽

Visual Analogue Scale ◽

Analogue Scale ◽

Experimental Comparison ◽

Adult Health ◽

Health States ◽

Trade Off ◽

Considerable Heterogeneity

Abstract Objectives EQ-5D-Y-3L health states are valued by adults taking the perspective of a 10-year-old child. Compared to valuation of adult EQ-5D instruments, this entails two changes to the perspective: (i) child health states are valued instead of adult health states and: (ii) health states are valued for someone else instead of for oneself. Although earlier work has shown that these combined changes yield different values for child and adult health states that are otherwise equal, it currently remains unclear why. Hence, we aimed to disentangle the effects of both changes. Methods A sample of 205 students (mean age: 19.48) was surveyed. Each respondent completed visual analogue scale (VAS) and time trade-off (TTO) tasks for five EQ-5D-Y-3L states, using four randomly ordered perspectives: (i) self-adult (themselves), (ii) other-adult (someone their age), (iii) self-child (themselves as a 10-year-old), (iv) other-child (a child of 10 years old). We compared how each perspective impacted outcomes, precision and quality of EQ-5D-Y-3L valuation. Results Overall, differences between perspectives were consistent, with their direction being dependent on the health states and respondents. For VAS, the effect on outcomes of valuation depended on severity, but variance was higher in valuation with child perspectives. For TTO, we observed that EQ-5D-Y-3L states valued on behalf of others (i.e., children or adults) received higher valuations, but lower variances. Conclusion The use of a different perspective appears to yield systematic differences in EQ-5D-Y-3L valuation, with considerable heterogeneity between health states and respondents. This may explain mixed findings in earlier work.

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

Thrombosis and Haemostasis ◽

10.1160/th04-02-0075 ◽

2004 ◽

Vol 92 (12) ◽

pp. 1336-1341 ◽

Cited By ~ 40

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.

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

Medical Decision Making ◽

10.1177/0272989x19851049 ◽

2019 ◽

Vol 39 (4) ◽

pp. 380-392 ◽

Cited By ~ 4

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.

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