Development of the CFQ-R-8D: Estimating Utilities From the Cystic Fibrosis Questionnaire-Revised

Purpose Cystic fibrosis (CF) limits survival and negatively affects health-related quality of life (HRQOL). Cost-effectiveness analysis (CEA) may be used to make reimbursement decisions for new CF treatments; however, generic utility measures used in CEA, such as EQ-5D, are insensitive to meaningful changes in lung function and HRQOL in CF. Here we develop a new, CF disease–specific, preference-based utility measure based on the adolescent and adult version of the Cystic Fibrosis Questionnaire-Revised (CFQ-R), a widely used, CF-specific patient-reported measure of HRQOL. Methods Blinded CFQ-R data from 4 clinical trials (NCT02347657, NCT02392234, NCT01807923, and NCT01807949) were used to identify discriminating items for a classification system using psychometric (e.g., factor and Rasch) analyses. Thirty-two health states were selected for a time trade-off (TTO) exercise with a representative sample of the UK general population. TTO utility values were used to estimate a preference-based scoring algorithm by regression analysis (ordinary least squares, random effects maximum likelihood estimation [RE MLE]). Results A classification system with 8 dimensions (CFQ-R-8D; Physical Functioning, Vitality, Emotion, Role Functioning, Breathing Difficulty, Cough, Abdominal Pain, and Body Image) was generated. TTO was completed by 400 participants (mean age, 47.3 years; 49.8% female). Among regression models evaluated, the ordered RE MLE model was preferred, with predicted utility range from 0.257 to 1, no logical inconsistencies, and a mean absolute error of 0.038. Conclusion The CFQ-R-8D is the first disease-specific, preference-based scoring algorithm for CF, enabling estimation of disease-specific utilities for CEA based on the well-validated and widely used CFQ-R.

On the Stability of Social Preferences in Inter-Group Conflict: A Lab-in-the-Field Panel Study

Despite the omnipresence of inter-group conflicts, little is known about the heterogeneity and stability of individuals’ social preferences toward in-group and out-group members. To identify the prevalence and stability of social preferences in inter-group conflict, we gather quota-representative, incentivized data from a lab-in-the-field study during the heated 2016 Austrian presidential election. We assess social preferences toward in-group and out-group members one week before, one week after, and three months after the election. We find considerable heterogeneity in individuals’ group-(in)dependent social preferences. Utilizing various econometric strategies, we find largely stable social preferences over the course of conflict. Yet, there is some indication of variation, particularly when the conflict becomes less salient. Variation is larger in social preferences toward in-group members and among specific preference types. We discuss the theoretical implications of our findings and outline potential avenues for future research.