Can Independently Elicited Adult- and Child-Perspective Health-State Utilities Explain Priority Setting?

Objectives: Time trade-off (TTO) utilities for EQ-5D-Y-3L health states valued by adults taking a child's perspective are generally higher than their valuations of the same state for themselves. Ceteris paribus, the use of these utilities in economic evaluation implies that children gain less from treatments returning them to full health for a specified amount of time than adults. In this study, we explore if this implication affects individuals’ views of priority-setting choices between treatments for adults and children. Methods: We elicited TTO utilities for 4 health states in online interviews, in which respondents valued states for a 10-year-old child and another adult their age. Views on priority setting were studied with person trade-off (PTO) tasks involving the same health states. We tested the ability of the subjects’ TTO utilities to predict these societal choices in PTO. Results: There are no significant differences between adult and child health state valuations in our study, but we do observe a substantial preference for treating children over adults in the PTO task. Conclusions: Our findings suggest that perspective-dependent health-state utilities only explain a small part of views on priority setting between adults and children. External equity weights might be useful to better explain the higher priority given to children.</p

Correction to:Time and lexicographic preferences in the valuation of EQ-5D-Y with time trade-off methodology

The original article that was published contains errors in the abstract and result section head. Please find the corrected text with section heading.</p

A multidisciplinary study of an exceptional prehistoric waste dump in the mountainous inland of Calabria (Italy) : implications for reconstructions of prehistoric land use and vegetation in Southern Italy

The mountainous inland of northern Calabria (Southern Italy) is known for its sparse prehistoric human occupation. Nevertheless, a thorough multidisciplinary approach of field walking, geophysical survey and invasive research led to the discovery of a major archaeological archive. This archive concerns a rich multi-phased dump, spanning about 3000 years (Late Neolithic to Late Imperial Roman Age) and holding two Somma-Vesuvius tephra. Of these, the younger is a distinct layer of juvenile tephra from the Pompeii eruption, while the older concerns reworked tephra from the Bronze Age AP2 eruption (ca. 1700 cal. yr BP). The large dump contains abundant ceramics, faunal remains and charcoal, and most probably originated through long-continued deposition of waste in a former gully like system of depressions. This resulted in an inversed, mound-like relief, whose anthropogenic origin had not been recognized in earlier research. The tephras were found to be important markers that support the reconstruction of the occupational history of the site. The sequence of occupational phases is very similar to that observed in a recent palaeoecological study from nearby situated former lakes (Lago Forano/Fontana Manca). This suggests that this sequence reflects the more regional occupational history of Calabria, which goes back to ca. 3000 BC. Attention is paid to the potential link between this history and Holocene climatic phases, for which no indication was found. The history deviates strongly from histories deduced from the few, but major palaeorecords elsewhere in the inlands of Southern Italy (Lago Grande di Monticchio and Lago Trifoglietti). We conclude that major regional variation occurred in prehistoric land use and its impacts on the vegetation cover of Southern Italy, and studies of additional palaeoarchives are needed to unravel this complex history. Finally, shortcomings of archaeological predictive models are discussed and the advantages of truly integrated multidisciplinary research

The way that you do it? An elaborate test of procedural invariance of TTO, using a choice-based design

The time tradeoff (TTO) method is often used to derive Quality-Adjusted Life Year health state valuations. An important problem with this method is that results have been found to be responsive to the procedure used to elicit preferences. In particular, fixing the duration in the health state to be valued and inferring the duration in full health that renders an individual indifferent, causes valuations to be higher than when the duration in full health is fixed and the duration in the health state to be valued is elicited. This paper presents a new test of procedural invariance for a broad range of time horizons, while using a choice-based design and adjusting for discounting. As one of the known problems with the conventional procedure is the violation of constant proportional tradeoffs (CPTO), we also investigate CPTO for the alternative TTO procedure. Our findings concerning procedural invariance are rather supportive for the TTO procedure. We find no violations of procedural invariance except for the shortest gauge duration. The results for CPTO are more troublesome: TTO scores depend on gauge duration, reinforcing the evidence reported when using the conventional procedure

On the (not so) constant proportional trade-off in TTO

Abstract. Purpose: The linear and power QALY models require that people in Time Trade-off (TTO) exercises sacrifice the same proportion of lifetime to obtain a health improvement, irrespective of the absolute amount. However, evidence on these constant proportional trade-offs (CPTOs) is mixed, indicating that these versions of the QALY model do not represent preferences. Still, it may be the case that a more general version of the QALY model represents preferences. This version has the property that people want to sacrifice the same proportion of utilities of lifetime for a health improvement, irrespective of the amount of this lifetime. Methods: We use a new method to correct TTO scores for utility of life duration and test whether decision makers trade off utility of duration and quality at the same rate irrespective of duration. Results: We find a robust violation of CPTO for both uncorrected and corrected TTO scores. Remarkably, we find higher values for longer durations, contrary to most previous studies. This represents the only study correcting for utility of life duration to find such a violation. Conclusions: It seems that the trade-off of life years is indeed not so constantly proportional and, therefore, that health state valuations depend on durations

Time to tweak the TTO: results from a comparison of alternative specifications of the TTO

Abstract This article examines the effect that different specifications of the time trade-off (TTO) valuation task may have on values for EQ-5D-5L health states. The new variants of the TTO, namely lead-time TTO and lag-time TTO, along with the classic approach to TTO were compared using two durations for the health states (15 and 20 years). The study tested whether these methods yield comparable health-state values. TTO tasks were administered online. It was found that lag-time TTO produced lower values than lead-time TTO and that the difference was larger in the longer time frame. Classic TTO values most resembled those of the lag-time TTO in a 20-year time frame in terms of mean absolute difference. The relative importance of different domains of health was systematically affected by the duration of the health state. In the tasks with a 10-year health-state duration, anxiety/ depression had the largest negative impact on health-state values; in the tasks with a 5-year duration, the pain/discomfort domain had the largest negative impact

Discounting in Economic Evaluations

Appropriate discounting rules in economic evaluations have received considerable attention in the literature and in national guidelines for economic evaluations. Rightfully so, as discounting can be quite influential on the outcomes of economic evaluations. The most prominent controversies regarding discounting involve the basis for and height of the discount rate, whether costs and effects should be discounted at the same rate, and whether discount rates should decline or stay constant over time. Moreover, the choice for discount rules depends on the decision context one adopts as the most relevant. In this article, we review these issues and debates, and describe and discuss the current discounting recommendations of the countries publishing their national guidelines. We finish the article by proposing a research agenda