Cultural Values: Can They Explain Differences in Health Utilities between Countries?

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Preference Reversals: Violations of Unidimensional Procedure Invariance

Preference reversals have usually been explained by weighted additive models, in which different tasks give rise to different importance weights for the stimulus attributes, resulting in contradictory trade-offs. This article presents a preference reversal of a more extreme nature. Let (10, 5 Migr) denote living 10 years with a migraine for 5 days per week. Many participants preferred (10, 5 Migr) to (20, 5 Migr). However, when asked to equate these two options with a shorter period of good health, they usually demanded more healthy life years for (20, 5 Migr) than for (10, 5 Migr). This preference reversal within a single dimension cannot be explained by different importance weights and suggests irrationalities at a more fundamental level. Most participants did not change their responses after being confronted with their inconsistencies

The Better than Dead Method: Feasibility and Interpretation of a Valuation Study

Background Traditionally, the valuation of health states worse than being dead suffers from two problems: [1] the use of different elicitation methods for positive and negative values, necessitating arbitrary transformations to map negative to positive values; and [2] the inability to quantify that values are time dependent. The Better than Dead (BTD) method is a health-state valuation method where states with a certain duration are compared with being dead. It has the potential to overcome these problems. Objectives To test the feasibility of the BTD method to estimate values for the EQ-5D system. Methods A representative sample of 291 Dutch respondents (aged 18-45 years) was recruited. In a web-based questionnaire, preferences were elicited for a selection of 50 different health states with six durations between 1 and 40 years. Random-effects models were used to estimate the effects of socio-demographic and experimental variables, and to estimate values for the EQ-5D. Test-retest reliability was assessed in 41 respondents. Results Important determinants for BTD were a religious life stance [odds ratio 4.09 (2.00-8.36)] and the educational level. The fastest respondents more often preferred health-state scenarios to being dead and had lower test-retest reliability (0.45 versus 0.77 and 0.84 for fast, medium and slow response times, respectively). The results showed a small number of so-called maximal endurable time states. Conclusion Valuating health states using the BTD method is feasible and reliable. Further research should explore how the experimental setting modifies how values depend on time

Utilities and patient preferences discrepancies between chained and classic utilities induced by anchoring with occasional adjustments

Item does not contain fulltextBackground: Classic utility assessment uses death and perfect health as end points. Chained utility assessment uses other health states as end points. It has been previously noted that these two assessment procedures lead to different utilities. Purpose: To explain these discrepancies between chained and classic assessments. Methods: First, previous data are plotted in a uniform way to facilitate comparison. Second, using Time TradeOff and paired comparison data, we estimate the extent to which respondents adjust their responses when end points are varied. Data were obtained in various samples: in healthy volunteers from the general public, in students, and in women at high risk for breast cancer seeking genetic counseling. Results: We obtained 741 valid data records from a total of 106 participants. Our own data replicate the pattern found previously: when compared to classic utilities 1) Chained utilities are smaller (larger) when the best (worst) end point varies, 2) the discrepancies become smaller for utilities near 0 and 1. Our data reveal that there is a distinct failure to adjust responses when the end points are varied. The latter finding explains the robust pattern of discrepancies. Conclusions: Decision analyses that use a mix of classic and chained utilities are not on firm ground. One should be wary of normative interpretations of new value assessment procedures. Alternative interpretations of our findings are discussed

Adherence and decision AIDS: a model and a narrative review

BACKGROUND: Patient adherence to medication or lifestyle interventions is a serious concern. Interventions to improve adherence exist, but their effects are usually small. Several authors suggested that decision aids may positively affect adherence. OBJECTIVE: . This presentation examines the role of decision aids in adherence research through development of a model and a narrative review. METHODS: and RESULTS: . I: A model was developed to organize pathways relating decision aids and adherence. There is clinical evidence for these pathways, suggesting that decision aids may potentially improve adherence. The model is helpful when considering measures to study decision aids and adherence. II: A narrative review of decision aids and adherence was done. A systematic search resulted in 11 randomized studies. Two studies, both in the hypertension management domain, were positive. Shortcomings were identified regarding the range of adherence measures, the sample size, and the STUDY DESIGN: It is argued that outcomes for the option "nonadherent" behavior should be described explicitly in the decision aid to inform patients about the costs and benefits of nonadherent behavior. CONCLUSIONS: . A relation between decision aids and adherence is plausible in view of the psychological and medical literature. A systematic search showed that experimental evidence relating decision aids and adherence is inconclusive. Rigorous trials on this topic are worthwhile. Such trials should employ adequate sample sizes, multiple adherence measures, and a control arm delivering usual care. The decision aid should describe the option "being nonadherent" and its outcomes

Discrepancies between chained and classic utilities induced by anchoring with occasional adjustments.

BACKGROUND: Classic utility assessment uses death and perfect health as end points. Chained utility assessment uses other health states as endpoints. It has been previously noted that these 2 assessment procedures lead to different utilities. PURPOSE: The author attempts to explain these discrepancies between chained and classic assessments. METHOD: Previous data are plotted in a uniform way to facilitate comparison. Using time trade-off and paired-comparison data, the author estimates the extent to which respondents adjust their responses when end points are varied. Data were obtained in various samples: in healthy volunteers from the general public, in students, and in women at high risk for breast cancer seeking genetic counseling. RESULTS: The author obtained 741 valid data records from a total of 106 participants. The data replicate the pattern found previously. When compared to classic utilities, (1) chained utilities are smaller (larger) when the best (worst) endpoint varies and (2) the discrepancies become smaller for utilities near 0 and 1. The data reveal that there is a distinct failure to adjust responses when the end points are varied, as if the responses anchor on some master health scale. The latter finding explains the robust pattern of discrepancies. CONCLUSION: Decision analyses that use a mix of classic and chained utilities are not on firm ground. One should be wary of normative interpretations of new value assessment procedures. Alternative interpretations of the findings are discussed

Proportional heuristics in time tradeoff and conjoint measurement

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Prophylactic mastectomy is not a self-evident choice for women carrying a germ line BRCA1 or BRCA2 mutation: description and first results of a decision support procedure.

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