Abstract
Background
Discrete choice experiments (DCEs) have been proposed as a method to estimate utility weights for health states within utility instruments. However, the most appropriate method to anchor the utility values on the full health to dead quality-adjusted life year (QALY) scale remains uncertain. We test four approaches to anchoring in which dead is valued at zero and full health at one.
Methods
We use data from two DCEs valuing EQ-5D-3L and EQ-5D-5L health states, which presented pairs of health profiles with an associated duration, and a dead option. The approaches to anchoring the results on the required scale were (1) using only preferences between non-dead health profiles; (2) including the dead data, treating it as a health profile with zero duration; (3) explicitly modelling both duration and dead; and (4) using the preferences regarding the dead health state as an external anchor subsequent to the estimation of approach 1.
Results
All approaches lead to differences in the scale of utility decrements, but not the ranking of EQ-5D health states. The models differ in their ability to predict preferences around dead health states, and the characteristics of the value sets in terms of their range and the proportion of states valued as worse than dead.
Discussion
Appropriate anchoring of DCEs with or without complementary time trade-off (TTO) data remains unresolved, and the method chosen will impact on health resource allocation decision making employing the value sets.
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References
de Bekker-Grob EW, Ryan M, Gerard K. Discrete choice experiments in health economics: a review of the literature. Health Econ. 2012;21(2):145–72.
Bansback N, Brazier J, Tsuchiya A, Anis A. Using a discrete choice experiment to estimate societal health state utility values. J Health Econ. 2012;31:306–18. doi:10.1016/j.jhealeco.2011.11.004.
Norman R, Cronin P, Viney R. A pilot discrete choice experiment to explore preferences for EQ-5D-5L health states. Appl Health Econ Health Policy. 2013;11(3):287–98.
Norman R, Viney R, Brazier J, Burgess L, Cronin P, King MT, et al. Valuing SF-6D health states using a discrete choice experiment. Med Decis Making. 2014;34(6):773–86.
Stolk EA, Oppe M, Scalone L, Krabbe PFM. Discrete choice modeling for the quantification of health states: the case of the EQ-5D. Value Health. 2010;13(8):1005–13.
Viney R, Norman R, Brazier J, Cronin P, King MT, Ratcliffe J, et al. An Australian discrete choice experiment to value eq-5d health States. Health Econ. 2014;23(6):729–42. doi:10.1002/hec.2953.
Bleichrodt N, Wakker P, Johannesson M. Characterizing QALYs by risk neutrality. J Risk Uncertain. 1997;15(2):107–14.
McFadden D. Conditional logit analysis of qualitative choice behaviour. In: Zarembka P, editor. Frontiers in econometrics. New York: New York Academic Press; 1974. p. 105–42.
Thurstone LL. A law of comparative judgment. Psychol Rev. 1927;34:273–86.
Devlin NJ, Krabbe PF. The development of new research methods for the valuation of EQ-5D-5L. Eur J Health Econ. 2013;14(Suppl 1):S1–3. doi:10.1007/s10198-013-0502-3.
Oppe M, Devlin NJ, van Hout B, Krabbe PF, de Charro F. A program of methodological research to arrive at the new international EQ-5D-5L valuation protocol. Value Health. 2014;17(4):445–53. doi:10.1016/j.jval.2014.04.002.
Ramos-Goñi JM, Rivero-Arias O, Errea M, Stolk EA, Herdman M, Cabases JM. Dealing with the health state ‘dead’ when using discrete choice experiments to obtain values for EQ-5D-5L heath states. Eur J Health Econ HEPAC Health Econ Prev Care. 2013;14(Suppl 1):S33–42. doi:10.1007/s10198-013-0511-2.
Flynn T. Using conjoint analysis to estimate health state values for cost-utility analysis: issues to consider. Pharmacoeconomics. 2010;28(9):711–22.
Mulhern B, Bansback N, Brazier J, Buckingham K, Cairns J, Devlin N et al. Preparatory study for the revaluation of the EQ-5D tariff: methodology report. Health Technol Assess. 2014;18(12):vii–xxvi, 1–191. doi:10.3310/hta18120.
Flynn TN, Louviere JJ, Marley AA, Coast J, Peters TJ. Rescaling quality of life values from discrete choice experiments for use as QALYs: a cautionary tale. Popul Health Metrics. 2008;6:6.
Mulhern B, Longworth L, Brazier J, Rowen D, Bansback N, Devlin N, et al. Binary choice health state valuation and mode of administration: head-to-head comparison of online and CAPI. Value Health. 2013;16(1):104–13. doi:10.1016/j.jval.2012.09.001.
Street DJ, Burgess L. The construction of optimal stated choice experiments: theory and methods. Wiley series in probability and statistics. New Jersey: Wiley; 2007.
Rand-Hendriksen K, Augestad LA, Dahl FA, Kristiansen IS, Stavem K. A shortcut to mean-based time tradeoff tariffs for the EQ-5D? Med Decis Making. 2012;32(4):569–77. doi:10.1177/0272989X11431607.
Tsuchiya A, Dolan P. The QALY model and individual preferences for health states and health profiles over time: a systematic review of the literature. Med Decis Making. 2005;25(4):460–7. doi:10.1177/0272989X05276854.
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Conflict of interest
The authors (Norman, Mulhern, and Viney) declare no conflict of interests. Data collection was funded by a National Health and Medical Research Council Project Grant (403303).
Author contributions
Norman conceived and undertook the analysis, and was primarily responsible for drafting the manuscript. Mulhern helped to develop the approaches to anchoring explored in the analysis, and commented on and amended the draft manuscript. Viney was responsible for the design and collection of the underpinning data, and commented on and amended the draft manuscript.
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Appendix
Screenshots of the tasks in the two studies .
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Norman, R., Mulhern, B. & Viney, R. The Impact of Different DCE-Based Approaches When Anchoring Utility Scores. PharmacoEconomics 34, 805–814 (2016). https://doi.org/10.1007/s40273-016-0399-7
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DOI: https://doi.org/10.1007/s40273-016-0399-7