Elsevier

Value in Health

Volume 22, Issue 3, March 2019, Pages 370-376
Value in Health

Preference-Based Assessments
Valuation of Health States Considered to Be Worse Than Death—An Analysis of Composite Time Trade-Off Data From 5 EQ-5D-5L Valuation Studies

https://doi.org/10.1016/j.jval.2018.10.002Get rights and content
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Highlights

  • Previous studies have shown that EuroQol 5-dimensional questionnaire health states considered worse than death are more difficult to value than those considered better than death using the conventional time trade-off (TTO) method.

  • Our study shows that negative utility values derived from the lead time TTO method are poorly associated with severity of health states, suggesting poor discriminative ability of the lead time TTO method.

  • Further research is needed to understand respondents’ thought process when valuing health states that are considered worse than death. Development of less complex TTO procedures for valuation of very poor health states and modeling methods for predicting negative values is warranted.

Abstract

Objectives

To evaluate the discriminative ability of negative values measured in 5-level EuroQol 5-dimensional questionnaire (EQ-5D-5L) value set studies.

Methods

This is a secondary analysis of EQ-5D-5L value set studies from Singapore, the Netherlands, China, Thailand, and Canada in which health state values were elicited from a general population sample using a composite time trade-off (TTO) method. Mean values were calculated for health states with same severity. The association between the mean values and severity was evaluated using Pearson correlation (r). A linear mixed model using severity as the fixed effect was fitted for values. The analyses were performed separately for positive values (from a conventional TTO for health states considered “better than death”) and negative values (from a lead time TTO for health states considered “worse than death”).

Results

In Singapore (N = 1000; negative values 32.6%), the mean decreased with severity from 0.89 to 0.21 for positive values and increased with severity from −0.98 to −0.89 for negative values. The correlation between values and severity was much lower for negative values (r = −0.016) than for positive values (r = −0.614). The coefficient of severity in the linear mixed model for negative values was much smaller (coefficient = −0.009; pseudo-R2 < 0.001) compared with the model for positive values (coefficient = −0.041; pseudo-R2 = 0.337). Results using data sets from the other countries were similar.

Conclusions

Negative values are not associated with severity of health states in EQ-5D-5L valuation studies, suggesting poor discriminative ability of the lead time TTO method in valuing health states considered worse than death.

Keywords

EQ-5D
TTO
utility
valuation
worse than death

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