The value of health at different ages

Is the value of being healthy the same across all ages? The standard practice of economic evaluation assumes so, and does not discriminate between a QALY (Quality Adjusted Life Year) to an elderly person and one to a child. But on the other hand, it is possible to assume that the value of a healthy year is different according to age, as has been done with DALYs (Disability Adjusted Life Years). This paper is based on a series of interviews designed to elicit and to quantify preferences concerning health at different ages. There were three hypotheses to be tested: (1) that the relative value of health decreases with age, (2) that this decreasing profile is independent of a respondent’s age, and (3) that this age-related preference can be expressed on an interval scale. The results obtained did turn out to depend on a respondent’s age: a mostly negative age-value profile was obtained from younger respondents, but the profile from older respondents had a peak at middle age. Thus, the 1st and 2nd hypotheses were largely rejected. The 3rd hypothesis cannot be rejected, but it should be noted that the variance of the responses was large, thus rendering rejection somewhat less likely. To conclude, the respondents valued a unit of health differently, depending on the age of the patient. While this study does not attempt to determine the exact continuous age-value profile, it found the profile clearly declining beyond middle age.health, QALYs, age

Health mobility: implications for efficiency and equity in priority setting

Adverse Health mobility is a statistical measure of inter-temporal fluctuations in health of a group of individuals. Increased availability of panel data has led to a number of studies which analyse and compare health mobility across subgroups. Mobility can differ systematically across patient subgroups, even if prevalence measured at one point in time is the same. There is a lack of discussion regarding whether health mobility is a relevant concept for resource allocation decisions. In this think piece, we explore whether and how health mobility is incorporated in cost-effectiveness analysis (CEA). CEA takes health mobility into account where it matters in terms of efficiency and -depending on treatment programs- either favours groups with low mobility or gives equal priority to groups of differing levels of mobility. However, CEA fails to take into account the equity dimension of mobility. There is qualitative research to suggest that some members of the public find that patient groups with low health mobility should be given priority even if some efficiency was sacrificed. Results also indicate that this may depend on the nature of the condition, the actual lengths involved and the magnitude of the efficiency sacrifice. Health mobility may also have political implications which affect resource allocation decisions, possibly in opposing directions. Further research is required to investigate the extent to which the public is concerned with health mobility, to determine conditions for which health mobility matters most, and to explore ways of how the equity dimension of health mobility can be incorporated into CEA.Health mobility, health dynamics, panel data, resource allocation, cost effectiveness analysis, equity

Health Dynamics: Implications for Efficiency and Equity in Priority Setting

AbstractHealth dynamics are intertemporal fluctuations in health status of an individual or a group of individuals. It has been found in empirical studies of health inequalities that health dynamics can differ systematically across subgroups, even if prevalence measured at one point in time is the same. We explore the relevance of the concept of health dynamics in the context of cost-effectiveness analysis. Although economic evaluation takes health dynamics into account where they matter in terms of efficiency, we find that it fails to take into account the equity dimensions of health dynamics. In addition, the political implications of health dynamics may influence resource allocation decisions, possibly in opposing directions

Sick but satisfied: the impact of life and health satisfaction on choice between health scenarios

Preference elicitation methods require respondents to predict the impact a change in health might have on their future selves. The focus on the change in health is at the possible expense of other experiences of life once in that health state. We analyse personal preferences to a pairwise choice task involving trade-offs between quality and length of life, where satisfaction levels with life or health are introduced in the description of the health states. We find that a health scenario including low levels of satisfaction increases the likelihood of preferring to die sooner in full health, whereas scenarios including high levels of satisfaction increase the likelihood of preferring to live for longer in poor health. The differences highlight the sensitivity of preferences to what is described in health states and therefore show the importance of on-going discussions about precisely what respondents should be asked to consider in preference elicitation studies

Constraint Propagation of C2C^2-adjusted Formulation - Another Recipe for Robust ADM Evolution System

With a purpose of constructing a robust evolution system against numerical instability for integrating the Einstein equations, we propose a new formulation by adjusting the ADM evolution equations with constraints. We apply an adjusting method proposed by Fiske (2004) which uses the norm of the constraints, C2. One of the advantages of this method is that the effective signature of adjusted terms (Lagrange multipliers) for constraint-damping evolution is pre-determined. We demonstrate this fact by showing the eigenvalues of constraint propagation equations. We also perform numerical tests of this adjusted evolution system using polarized Gowdy-wave propagation, which show robust evolutions against the violation of the constraints than that of the standard ADM formulation.Comment: 11 pages, 5 figures. To be published in Phys. Rev.

SIPHER-7: a seven-indicator outcome measure to capture wellbeing for economic evaluation

The SIPHER (Systems Science in Public Health and Health Economics Research) Consortium examines the complex causal relationships between upstream policies and wellbeing, economic and equality outcomes, and in so doing, it needs a common set of wellbeing indicators. This note outlines how the seven indicators that form the SIPHER- 7 were selected by members of the Consortium through an iterative consultation process. An Appendix presents a series of descriptive statistics to illustrate SIPHER-7 in the UK general population, using the UK Household Longitudinal Study “Understanding Society”, wave 9 from 2018

Review of SIPHER-7 wellbeing indicators

The SIPHER (Systems Science in Public Health and Health Economics Research) Consortium examines the complex causal relationships between upstream policies and wellbeing, economic and equality outcomes, and in so doing, it needs a common set of wellbeing indicators. SIPHER-7 is a suite of seven wellbeing indicators developed for this purpose between October 2019 and February 2020. This note reports on a subsequent review conducted in March 2022, to improve the clarity of the item wording, and the link between SIPHER-7 and the UK Household Longitudinal Study (“Understanding Society”)

Preparatory study for the revaluation of the EQ-5D tariff: methodology report.

BACKGROUND: EQ-5D is a widely used generic measure of health with a 'tariff', or preference weights, obtained from the general population, using time trade-off (TTO). PRET (Preparatory study for the Re-valuation of the EQ-5D Tariff project) contributes towards the methodology for its revaluation. METHODS: Stage 1 examined key assumptions typically involved in health-state valuations through a series of binary choice exercises, namely that health-state preferences are independent of (1) duration of the state; (2) whose health it is (i.e. perspective); (3) length of 'lead time' (a mechanism to value all states on the same scale, including those who are worse than being dead); (4) when health events take place (time preference); and (5) satisfaction associated with the state. Further topics addressed were (6) exhaustion of lead time in the worst state; (7) health-state valuation using discrete choice experiments (DCEs) with a duration attribute; and (8) binary choice administration of lead time - time trade-off (LT-TTO). Stage 1 consisted of an online survey with 6000 respondents. Stage 2 compared the results above to those of an identical survey conducted in 200 face-to-face computer-assisted personal interviews (CAPIs), covering topics (1) to (7). Stages 3 and 4 examined - in more detail and depth - issues taken from stage 1. Stage 3 consisted of CAPI surveys of a representative UK sample of 300, using examples of TTO, LT-TTO, and DCE with duration, each followed by extensive feedback questions. Stage 4 was a more intensive exercise involving a qualitative analysis of people's thought processes during both binary choice and iterative health-state valuation exercises. Data were collected through 'think-aloud' methods in 30 interviews of a convenience sample. RESULTS: Stage 1 found that health-state values are not independent of (1) duration of the state but there is no clear pattern; (2) whose health it is; (3) the duration of 'lead time' but there was no clear pattern; (4) when health events take place; or (5) satisfaction associated with the state. Furthermore, (6) exhaustion of lead time in the worst state was subject to substantial framing effects; (7) the five-level version of the EQ-5D (EQ-5D-5L) can be valued using DCE with duration as an attribute; and (8) binary choice LT-TTO can be administered in an online environment. Stage 2 found that although online surveys and CAPI surveys resulted in different compositions of respondents, at the aggregate, their responses to the experimental questions covering (1) to (7) above were not statistically significantly different from each other. Stages 3 and 4 found that TTO and LT-TTO were easier than DCE with duration; respondents did not necessarily trade across all attributes of EQ-5D; some respondents found it difficult to distinguish between the two worst levels of EQ-5D-5L, and some respondents may be thinking about the impact of their ill health on their family. CONCLUSIONS: In order for the National Institute for Health and Care Excellence to make the most appropriate decisions, the EQ-5D tariff needs to incorporate the latest understanding of health-state preferences. PRET contributed to the knowledge base on the conduct of health-state valuation studies. FUNDING: The Medical Research Council (MRC)-National Institute for Health Research (NIHR) Methodology Research Programme funded the PRET project (MRC ref. G0901500), and the EuroQol Group funded the PRET-AS project (Preparatory study for the Re-valuation of the EQ-5D Tariff project - Additional Sample) as an extension to the PRET project with formal agreement from the MRC

Implausible states: prevalence of EQ-5D-5L states in the general population and its effect on health state valuation

The EQ-5D is made up of health state dimensions and levels, in which some combinations seem less “plausible” than others. If “implausible” states are used in health state valuation exercises, then respondents may have difficulty imagining them, causing measurement error. There is currently no standard solution: some valuation studies exclude such states, whereas others leave them in. This study aims to address 2 gaps in the literature: 1) to propose an evidence-based set of the least prevalent two-way combinations of EQ-5D-5L dimension levels and 2) to quantify the impact of removing perceived implausible states from valuation designs. For the first aim, we use data from 2 waves of the English General Practitioner Patient Survey (n = 1,639,453). For the second aim, we remodel a secondary data set of a Discrete Choice Experiment (DCE) with duration that valued EQ-5D-5L and compare across models that drop observations involving different health states: 1) implausible states as defined in the literature, 2) the least prevalent states identified in stage 1, and 3) randomly select states, alongside 4) a model that does not drop any observations. The results indicate that two-way combinations previously thought to be implausible actually exist among the general population; there are other combinations that are rarer, and removing implausible states from an experimental design of a DCE with duration leads to value sets with potentially different characteristics depending on the criterion of implausible states. We advise against the routine removal of implausible states from health state valuation studies