A uniform Time Trade Off method for states better and worse than dead: feasibility study of the ‘lead time’ approach

The way Time Trade Off (TTO) values are elicited for states of health considered ‘worse than being dead’ has important implications for the mean values used in economic evaluation. Conventional approaches to TTO, as used in the UK’s ‘MVH’ value set, are problematic because they require fundamentally different tradeoffs tasks for the valuation of states better and worse than dead. This study aims to refine and test the feasibility of a new approach described by Robinson and Spencer (2006), and to explore the characteristics of the valuation data it generates. The approach introduces a ‘lead time’ into the TTO, producing a uniform procedure for generating values either >0 or <0. We used this lead time TTO to value 10 moderate to severe EQ-5D states using a sample of the general public (n=109). We conclude that the approach is feasible for use in valuation studies, and appears to overcome the discontinuity in values around 0 evident in conventional methods. However, further research is required to resolve the issue of how to handle participants who ‘use up’ all lead time; to develop ways of controlling for individual time preferences; and to better understand the implications for valuations of states better than dead

Does the value of quality of life depend on duration?

The aims of this study are to investigate the feasibility of eliciting Time Trade Off (TTO) valuations using short durations; to determine the effect of contrasting durations on individuals’ responses to the TTO; to examine variations within and between respondents’ values with respect to duration; and to consider the insights provided by participants’ comments and explanations regarding their reaction to duration in the valuation task. 27 participants provided TTO values using short and long durations for three EQ-5D states. Feedback was sought using a series of open ended questions. Of the 81 opportunities to observe it, strict constant proportionality was satisfied twice. 11 participants had no systematic relationship between duration and value; 11 provided consistently lower valuations in long durations, while 5 had higher valuations in long durations. Comments provided by participants were consistent with the values they provided. Mean TTO values did not differ markedly between alternative durations. We conclude that it is feasible to elicit TTO values for short durations. There is considerable heterogeneity in individuals’ responses to the time frames used to elicit values. Further research is required to ensure that the values used in cost effectiveness analysis adequately represent preferences about quality and length of life

Measuring the value of life: Exploring a new method for deriving the monetary value of a QALY

Economic evaluations of new health technologies now typically produce an incremental cost per Quality Adjusted Life Year (QALY) value. The QALY is a measure of health benefit that combines length of life with quality of life, where quality of life is assessed on a scale where zero represents a health state equivalent to being dead and one represents full health. The challenge for decision makers, such as the Treasury, is to determine the appropriate size of the healthcare budget. Bodies such as the National Institute for Health and Clinical Excellent (NICE) in the U.K. must then determine how much they can afford to pay for a gain of one QALY, while operating under this fixed budget. While there is no fixed cost-effectiveness threshold and each intervention is assessed on a case by case basis, under normal circumstances the threshold will not be below £20,000 and not above £30,000 per QALY. Recent research has sought to determine the monetary value individuals place on a QALY to inform the size of the healthcare budget and the level of the cost-effectiveness threshold. This research has predominantly used Willingness to Pay (WTP) approaches. However, WTP has a number of known problems, most notably its insensitivity to scope. In this paper we present an alternative approach to estimating the monetary value of a QALY (MVQ), which is based upon a Time Trade Off (TTO) exercise of income with health held constant at perfect health. We present the methods and theory underlying this experimental approach and some results from an online feasibility study in the Netherlands

The impact of losses in income due to ill health: does the EQ-5D reflect lost earnings?

Two key questions in the context of UK health policy are: do the published preference indices for EQ-5D reflect the impact of lost earnings? Are we currently implicitly including indirect costs in our analyses? It is crucial to investigate whether or not individuals take into account any possible impact of lost income in health state valuation exercises. If respondents do consider income effects, and these considerations change valuations, then these effects would need to be excluded both under the current NICE reference case, or where productivity costs are included in the numerator to avoid double counting. This study adapts the study design used to generate population value sets for EQ-5D, as first used in the Measurement and Valuation of Health (MVH) Study, and carries out valuations of hypothetical EQ-5D states using Time Trade Off (TTO) exercises through an online survey administered in the Netherlands. Furthermore, this study uses a number of different TTO questions to explore the impact of losses in income on the valuation of hypothetical health states, and to determine the relationship between income and health.EQ-5D; time trade-off; health-related loss of income

Prikaz knjige: Zorislav Kaleb - Djelovanje kaznene presude na parnični postupak /Vizura, Zagreb, 2008./

Nedavno je u izdanju nakladničke kuće Vizura objavljena knjiga mr. sc. Zorislava Kaleba, suca Kaznenog odjela Općinskog suda u Zagrebu, Djelovanje kaznene presude na parnični postupak s podnaslovom Vezanost parničnog suda za pravomoćnu presudu kaznenog suda. Knjiga Djelovanje kaznene presude na parnični postupak predstavlja autorov izra¬đeni i obranjeni magistarski rad na poslijediplomskom znanstvenom studiju iz trgovačkog prava i prava društava na Pravnom fakultetu Sveučilišta u Zagrebu dana 4. travnja 2006. godine na temu Vezanost parničnog suda za pravomoćnu presudu kaznenog suda pred Povjerenstvom koje su činili akademik Jakša Barbić, predsjednik Povjerenstva, prof. dr. se. Mihajlo Dika kao mentor, te prof. dr. se. Davor Krapac i dr. se. Branko Vukmir kao članovi Povjerenstva. Isti rad je autor u međuvremenu dijelom prilagodio radi objave kao monografije, a također je unio i izmjene koje su se u međuvremenu dogodile našem pozitivnom zakonodavstvu. U knjizi se obrađuje odnos između parničnog i kaznenog postupka, vezanost par¬ničnog suda za pravomoćnu osuđujuću presudu kaznenog suda po tužbi iz istog događaja, prejudicijelno djelovanje presude kaznenog suda na parnični postupak, djelovanje kaznene presude kao pravno relevantne činjenice u parničnom postupku, prekid postupka po od¬luci suda u parničnom postupku, donošenje pravomoćne kaznene presude kao razlog za ponavljanje parničnog postupka, te neki zaključni prijedlozi de legeferenda. Rad dijelom komparativno obrađuje istu materiju i u nekim drugim zakonodavstvima u opsegu koliko je to zanimljivo za našeg praktičara. Knjiga je rezultat dvogodišnjeg istraživanja autora prvenstveno odluka Županijskog suda u Zagrebu i Vrhovnog suda Republike Hrvatske, te potom i dostupnih odluka drugih domaćih i stranih sudova

Challenges and novel approaches for investigating molecular mediation

Understanding mediation is useful for identifying intermediates lying between an exposure and an outcome which, when intervened upon, will block (some or all of) the causal pathway between the exposure and outcome. Mediation approaches used in conventional epidemiology have been adapted to understanding the role of molecular intermediates in situations of high-dimensional omics data with varying degrees of success. In particular, the limitations of observational epidemiological study including confounding, reverse causation and measurement error can afflict conventional mediation approaches and may lead to incorrect conclusions regarding causal effects. Solutions to analysing mediation which overcome these problems include the use of instrumental variable methods such as Mendelian randomization, which may be applied to evaluate causality in increasingly complex networks of omics data

Appropriate inclusion of interactions was needed to avoid bias in multiple imputation

OBJECTIVE: Missing data are a pervasive problem, often leading to bias in complete records analysis (CRA). Multiple imputation (MI) via chained equations is one solution, but its use in the presence of interactions is not straightforward. STUDY DESIGN AND SETTING: We simulated data with outcome Y dependent on binary explanatory variables X and Z and their interaction XZ. Six scenarios were simulated (Y continuous and binary, each with no interaction, a weak and a strong interaction), under five missing data mechanisms. We use directed acyclic graphs to identify when CRA and MI would each be unbiased. We evaluate the performance of CRA, MI without interactions, MI including all interactions, and stratified imputation. We also illustrated these methods using a simple example from the National Child Development Study (NCDS). RESULTS: MI excluding interactions is invalid and resulted in biased estimates and low coverage. When XZ was zero, MI excluding interactions gave unbiased estimates but overcoverage. MI including interactions and stratified MI gave equivalent, valid inference in all cases. In the NCDS example, MI excluding interactions incorrectly concluded there was no evidence for an important interaction. CONCLUSIONS: Epidemiologists carrying out MI should ensure that their imputation model(s) are compatible with their analysis model