Deriving time discounting correction factors for TTO tariffs

The Time Tradeoff (TTO) method is a popular method for valuing health state utilities and is frequently used in economic evaluations. However, this method produces utilities that are distorted by several biases. One important bias entails the failure to incorporate time discounting. This paper aims to measure time discounting for health outcomes in a sample representative for the general population. In particular, we estimate TTO scores alongside time discounting in order to derive a set of correction factors that can be employed to correct raw TTO scores for the downward bias caused by time discounting. We find substantial positive correction factors, which are increasing with the severity of the health state. Furthermore, higher discounting is found when using more severe health states in the discounting elicitation task. More research is needed to further develop discount rate elicitation procedures and test their validity, especially in general public samples. Moreover, future research should investigate the correction of TTO score for other biases as well, such as loss aversion, and to develop a criterion to test the external validity of TTO scores.Discounting; QALY model; Time Tradeoff; Utility Measurement

In search of a preferred preference elicitation method: A test of the internal consistency of choice and matching tasks

The numerous reports on preference reversals in preference elicitations pose a great challenge to empirical economics. Many studies have found that different procedures may generate substantially different preferences. However, little is known about whether one procedure is more susceptible to preference reversals than another. Therefore, taking the preference reversals as a robust behavioral pattern, guidelines are called for to provide directions regarding a preferred preference elicitation task. This paper puts forward a new test of the internal consistency of choice and matching tasks, based on “internal preference reversals”. We replicate the preference reversal phenomenon and find a significant higher consistency within choice tasks than within matching tasks.preference reversal; internal consistency; scale compatibility; loss aversion; choice; matching

De basis van het pakket: Urgente uitdagingen voor de opzet en inzet van economische evaluaties in de zorg

Rede, in verkorte vorm uitgesproken bij de aanvaarding van het ambt van bijzonder hoogleraar Economische Evaluatie en Gezondheidszorgbeleid aan het instituut Beleid & Management Gezondheidszorg van de Faculteit der Geneeskunde en Gezondheidswetenschappen, Erasmus Universiteit Rotterdam, vanwege de Vereniging Trustfonds EUR, op 4 december 200

The inclusion of spill-over effects in economic evaluations

__Introduction__ Increasingly, welfare economic evaluations are used in the context of the allocation of scarce healthcare resources. Many jurisdictions prescribe their use in the context of reimbursement, funding, and/or pricing of new health technologies, especially pharmaceuticals. The fact that the outcomes of such evaluations can infuence actual allocation decisions in healthcare underlines the importance of a sound methodology and an appropriate decision-making process. Fortunately, in both areas progress has been made over the past decades. However, there remains room for further improvement, for instance in fnding appropriate estimates of monetary values of health, developing broader outcome measures than quality-adjusted life-years (QALYs), fnding appropriate equity (principles to estimate) weights for health outcomes, and estimating health opportunity costs

The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets

Compares systems of universal insurance coverage based on individual mandates, consumer choice of health plans, and regulated insurance market competition in Switzerland and the Netherlands. Discusses insights and implications for U.S. reform efforts