scholarly journals Quality-adjusted life year weights and treatment bias: Theory and evidence from cognitive interviews

2019 ◽  
Vol 7 ◽  
pp. 205031211985698 ◽  
Author(s):  
Bryan N Patenaude ◽  
Till Bärnighausen
Keyword(s):  
Standard Gamble ◽  
Stated Preference ◽  
Preference Elicitation ◽  
Quality Adjusted Life Year ◽  
Health State ◽  
Cognitive Interviews ◽  
Thought Processes ◽  
Health States ◽  
Treatment Bias ◽  
Quality Adjusted Life

Objectives: The purpose of this research is to understand the thought processes that underpin responses to stated preference approaches for eliciting quality of life, in particular the standard gamble. Methods: We utilize standard gamble preference elicitation survey techniques to elicit quality-adjusted life year weights for two reduced health states: chronic severe depression and total blindness. After the survey, we conduct open-ended qualitative interviews with respondents to determine their thought processes while taking the surveys and to shed light on what their quality-adjusted life year weight is capturing. Survey responses were coded and analyzed for themes in NVivo, the results of which were then formalized in the terminology of decision sciences. Results: The qualitative results of the cognitive interviews present systematic evidence for a type of cognitive bias present in standard gamble quality-adjusted life year weight elicitation, which has not been previously highlighted and which we call treatment bias. We define this treatment bias as the consideration of salient treatment alternatives correlated with a reduced health state, when these alternatives are not explicitly posed in the question. Our formalization of this cognitive behavior demonstrates that treatment bias will always bias the elicited health state utility of treating the illness in question downward. Conclusion: The treatment bias highlighted in this study has implications for economic evaluation when comparing treatment for illnesses where alternative treatments are widely publicized versus those that are not. For example, comparing the effectiveness of treating depression versus arthritis may be biased against depression if advertisements for anti-depressants are more widely viewed by survey respondents than advertisements for arthritis treatments. We propose a statement to be imbedded in all questionnaires regarding stated preference elicitation of quality-adjusted life year weights in order to correct for this bias in future stated preference surveys.

EFFECT OF INCLUDING (VERSUS EXCLUDING) FATES WORSE THAN DEATH ON UTILITY MEASUREMENT

2003 ◽  
Vol 19 (2) ◽  
pp. 347-361 ◽  
Author(s):  
Duska M. Franic ◽  
Dev S. Pathak
Keyword(s):  
Standard Gamble ◽  
Cancer Recurrence ◽  
Quality Adjusted Life Year ◽  
Health States ◽  
Cross Sectional ◽  
Test Analysis ◽  
Study Results ◽  
Economic Analyses ◽  
The Impact ◽  
Quality Adjusted Life

Objectives: Most studies typically measure health preferences excluding health states perceived as worse than death. The objective of this study is to test the impact of including (versus excluding) health states perceived to be worse than death on utility measurementusing standard gamble (SG) and visual analogue scale (VAS) methods.Methods: By means of a cross-sectional descriptive study design, women were asked to rate the utility of three hypothetical breast cancer health states: cure, treatment, and recurrence (n=119). Preference weights were estimated, allowing for negative utilities with death (perfect health) scaled at zero (1.0).Results: Unpaired t-test analysis showed significantly greater change in SG and VAS weights for individuals perceiving cancer recurrence as worse than death than those perceiving death as least desirable state. Excluding negative utilities from the study resulted in significantly smaller changes in utility. Study results show that preference elicitation methods can be successfully adapted to acquire negative utilities.Conclusions: Changes in utility were greater when negative preferences were permitted. Addressing negative preference scores could significantly affect quality adjusted life year estimates in economic analyses.

Against lifetime QALY prioritarianism

2017 ◽  
Vol 44 (2) ◽  
pp. 109-113 ◽  
Author(s):  
Anders Herlitz
Keyword(s):  
Priority Setting ◽  
Quality Adjusted Life Year ◽  
Health State ◽  
Health States ◽  
Health Related ◽  
Reasonable Ground ◽  
Quality Adjusted Life

Lifetime quality-adjusted life-year (QALY) prioritarianism has recently been defended as a reasonable specification of the prioritarian view that benefits to the worse off should be given priority in health-related priority setting. This paper argues against this view with reference to how it relies on implausible assumptions. By referring to lifetime QALY as the basis for judgments about who is worse off lifetime QALY prioritarianism relies on assumptions of strict additivity, atomism and intertemporal separability of sublifetime attributes. These assumptions entail that a health state at some period in time contributes with the same amount to how well off someone is regardless of intrapersonal and interpersonal distributions of health states. The paper argues that this is implausible and that prioritarians should take both intrapersonal and interpersonal distributions of goods into account when they establish who is worse off. They should therefore not accept that lifetime QALY is a reasonable ground for ascribing priority and reject lifetime QALY prioritarianism.

Disability discrimination and misdirected criticism of the quality-adjusted life year framework

2018 ◽  
Vol 44 (11) ◽  
pp. 793-795 ◽  
Author(s):  
David G T Whitehurst ◽  
Lidia Engel
Keyword(s):  
General Public ◽  
People With Disabilities ◽  
Quality Adjusted Life Year ◽  
Health State ◽  
Public Values ◽  
Health States ◽  
Preference Theory ◽  
Healthcare Decision Making ◽  
Patient Values ◽  
Quality Adjusted Life

Whose values should count – those of patients or the general public – when adopting the quality-adjusted life year (QALY) framework for healthcare decision making is a long-standing debate. Specific disciplines, such as economics, are not wedded to a particular side of the debate, and arguments for and against the use of patient values have been discussed at length in the literature. In 2012, Sinclair proposed an approach, grounded within patient preference theory, which sought to avoid a perceived unfair discrimination against people with disabilities when using values from the general public. Key assumptions about general public values that beget this line of thinking were that ‘disabled states always tally with lower quality of life’, and the use of standardised instruments means that ‘you are forced into a fixed view of disability as a lower value state’ (Sinclair, 2012). Drawing on recent contributions to the health economics literature, we contend that such assumptions are not inherent to the incorporation of general public values for the estimation of QALYs. In practice, whether health states of people with disabilities are of ‘lower value’ is, to some extent, a reflection of the health state descriptions that members of the public are asked to value.

scholarly journals Valuing Health for Clinical and Economic Decisions: Directions Relevant for Rheumatologists

2011 ◽  
Vol 38 (8) ◽  
pp. 1770-1775 ◽  
Author(s):  
MARK J. HARRISON ◽  
NICK J. BANSBACK ◽  
CARLO A. MARRA ◽  
MICHAEL DRUMMOND ◽  
PETER S. TUGWELL ◽  
...  
Keyword(s):  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Point Of View ◽  
Health State ◽  
Utility Analysis ◽  
Economic Decisions ◽  
Pros And Cons ◽  
Allocation Decisions ◽  
Qaly Approach ◽  
Quality Adjusted Life

The quality-adjusted life-year (QALY) is a construct that integrates the value or preference for a health state over the period of time in that health state. The main use of QALY is in cost-utility analysis, to help make resource allocation decisions when faced with choices. Although the concept of the QALY is appealing, there is ongoing debate regarding their usefulness and approaches to deriving QALY. In 2008, OMERACT engaged in an effort to agree on QALY approaches that can be used in rheumatology. Based on a Web questionnaire and a subsequent meeting, rheumatologists questioned whether it was relevant for OMERACT (1) to investigate use of a QALY that represents the patients’ perspective, (2) to explore the validity of the visual analog scale (VAS) to value health, and (3) to understand the validity of mapping health-specific instruments on existing preference instruments. This article discusses the pros and cons of these points in light of current insight from the point of view of health economics and decision-making theory. It also considers the further research agenda toward a QALY approach in rheumatology.

scholarly journals Estimating utility weights and quality-adjusted life year loss for colorectal cancer-related health states in Korea

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Jin Yong Lee ◽  
Minsu Ock ◽  
Min-Woo Jo ◽  
Woo-Seung Son ◽  
Hyeon-Jeong Lee ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Quality Adjusted Life Year ◽  
Health States ◽  
Quality Adjusted Life

L'effetto dell'esperienza della malattia sulla valutazione degli stati di salute

2009 ◽  
pp. 19-42
Author(s):  
Carmela Di Mauro ◽  
Daniela Giammanco ◽  
Eleonora Miano
Keyword(s):  
Standard Gamble ◽  
Rating Scale ◽  
Adaptive Behaviour ◽  
Health State ◽  
Health States ◽  
Current Health ◽  
Duration Of Illness ◽  
Experience Of Illness ◽  
The Impact ◽  
Health Valuation

- The issue of how respondents' characteristics influence preference-based valuations of health states has been addressed by the literature with a particular emphasis on the analysis of the effects of experience of illness. This study investigates the impact of experience of illness and of current health state on valuations provided by patients through three techniques, Standard Gamble, Rating Scale, and Time Trade-Off. This analysis complements the existing literature on the duration of illness and on adaptive behaviour, and sheds light on the way experience may affect health valuation according to the technique adopted. We use responses from 130 interviews administered to consecutively admitted patients of two cardiology units. Results show that the impact of the time elapsed since diagnosis is technique-specific: only in Standard Gamble estimates we find evidence that, the further away in time is the diagnosis, the lower the utility of the state.

Validity of utilities of patients with esophageal cancer

2005 ◽  
Vol 21 (1) ◽  
pp. 113-118 ◽  
Author(s):  
Peep F. M. Stalmeier ◽  
Angela G. E. M. de Boer ◽  
Mirjam A. G. Sprangers ◽  
Hanneke C. J. M. de Haes ◽  
Jan J. B. van Lanschot
Keyword(s):  
Esophageal Cancer ◽  
Convergent Validity ◽  
Standard Gamble ◽  
Health State ◽  
Health States ◽  
Curative Intent ◽  
Individual Level ◽  
Vas Scores ◽  
Actual Health ◽  
Good Agreement

Objectives: The convergent validity between utility assessment methods was assessed.Methods: Investigated were patients with esophageal cancer treated surgically with curative intent. Patients were interviewed in a period from 3 to 12 months after surgical resection. Patients evaluated their actual health and seven other states. Visual analogue scale (VAS) and standard gamble (SG) utilities were obtained for the health states in an interview. Patients also indicated whether or not they preferred death to living in a health state (worse than dead [WTD] preferences).Results: Fifty patients completed the interview. Convergent validity was excellent at the aggregate and individual level. However, the relation between VAS and SG differed strongly across individuals. On a scale from 0 (dead) to 100 (perfect health), SG scores were lower for patients with WTD preferences (mean difference d=35; p=.002); however, VAS scores did not vary by WTD preferences.Conclusions: In general, there is good agreement between VAS and SG measures, although patients disagree about how the VAS and SG are related. The standard gamble varied by WTD preferences, however, the VAS did not.

Benefits from improved health

2017 ◽  
Author(s):  
Jan Abel Olsen
Keyword(s):  
Quality Adjusted Life Year ◽  
Health State ◽  
Important Distinction ◽  
Equity Issues ◽  
Related Quality ◽  
Health Related ◽  
Returning To Work ◽  
Productivity Gains ◽  
Quality Adjusted Life

This chapter starts with an inquiry into the nature of different outcome measures that are being used in the medical literature, emphasizing an important distinction between incommensurable versus commensurable measures. The quality-adjusted life year (QALY) represents the most widely used commensurable metric. A key issue is how to value health-related quality of life (HRQoL) on a [0–1] scale by the use of health-state utility instruments. In addition to the health outcomes that are accounted for in the QALY measure, productivity gains might occur as a result of previously sick people returning to work. The chapter discusses the methodological and the equity issues involved when determining the extent to which production gains should be included in an economic evaluation. Finally, the theory behind the willingness-to-pay method is briefly explained, and contrasted with some measurement problems when applied as a way to value health benefits.

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