Constantly Proving The Opposite? A test of CPTO using a broad time horizon and correcting for discounting

Purpose: An important assumption underlying the quality-adjusted life year (QALY) model is that people trade off life years against health in the same proportion irrespective of the number of remaining life years. This is known as the constant proportional trade-offs (CPTO) condition. Previous studies have produced mixed empirical evidence about the validity of CPTO. This paper is the first to test CPTO using the time trade-off (TTO) method for a broad time horizon. Methods: In a sample of 83 students, we use a choice based TTO protocol to elicit TTO scores for back pain, using ten different gauge durations ranging between 1 and 46 years. The TTO scores are corrected for discounting, which is elicited by means of the direct method. Results: We find average TTO scores varying between 0.72 and 0.81. Although the scores do not differ much for different durations in absolute terms, some differences are significant, rejecting CPTO, with and without correcting for discounting. No clear relationship between TTO scores and gauge duration is found. An anchoring and rounding heuristic to some extent explains our results. Conclusions: Our findings highlight the importance of elicitation methods and context dependencies in QALY measurement and warrant detailed investigation of their influence

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

INVESTMENT IN ANTIVIRAL DRUGS:A REAL OPTIONS APPROACH

Real options analysis is a promising approach to model investment under uncertainty. We employ this approach to value stockpiling of antiviral drugs as a precautionary measure against a possible influenza pandemic. Modifications of the real options approach to include risk attitude and deviations from expected utility are presented. We show that risk aversion counteracts the tendency to delay investment for this case of precautionary investment, which is in contrast to earlier applications of risk aversion to real options analysis. Moreover, we provide a numerical example using real world data and discuss the implications of real options analysis for health policy. Suggestions for further extensions of the model and a comparison with the expected value of information analysis are put forward. Copyright (C) 2009 John Wiley & Sons, Ltd

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