Using rank data to estimate health state utility models

In this paper we report the estimation of conditional logistic regression models for the Health Utilities Index Mark 2 and the SF-6D, using ordinal preference data. The results are compared to the conventional regression models estimated from standard gamble data, and to the observed mean standard gamble health state valuations. For both the HUI2 and the SF-6D, the models estimated using ordinal data are broadly comparable to the models estimated on standard gamble data and the predictive performance of these models is close to that of the standard gamble models. Our research indicates that ordinal data have the potential to provide useful insights into community health state preferences. However, important questions remain

Estimating population cardinal health state valuation models from individual ordinal (rank) health state preference data

Ranking exercises have routinely been used as warm-up exercises within health state valuation surveys. Very little use has been made of the information obtained in this process. Instead, research has focussed upon the analysis of health state valuation data obtained using the visual analogue scale, standard gamble and time trade off methods. Thurstone’s law of comparative judgement postulates a stable relationship between ordinal and cardinal preferences, based upon the information provided by pairwise choices. McFadden proposed that this relationship could be modelled by estimating conditional logistic regression models where alternatives had been ranked. In this paper we report the estimation of such models for the Health Utilities Index Mark 2 and the SF-6D. The results are compared to the conventional regression models estimated from standard gamble data, and to the observed mean standard gamble health state valuations. For both the HUI2 and the SF-6D, the models estimated using rank data are broadly comparable to the models estimated on standard gamble data and the predictive performance of these models is close to that of the standard gamble models. Our research indicates that rank data has the potential to provide useful insights into community health state preferences. However, important questions remain

Testing the predective validity of the time trade-off and the Stardard Gamble

This paper tests the consistency of health utility measurements with individual preferences. We compare three methods, the time trade-off, the standard gamble and a version of the standard gamble that corrects for the deviations from expected utility modelled by prospect theory. Individual preferences are measured both through a ranking task and through a choice task. In decisions involving no risk the time trade-off is most consistent with people’s preferences with the standard gamble a close second. In decisions involving risk the corrected standard gamble is most consistent with people’s preferences. Our data do not support the common assumption in health economics that utility is transferable across decision contexts.Health utility measurement, QALYs,stardard gamble, time trade-off, prospect theory.

Estimating population cardinal health state valuation models from individual ordinal (rank) health state preference data

Ranking exercises have routinely been used as warm-up exercises within health state valuation surveys. Very little use has been made of the information obtained in this process. Instead, research has focussed upon the analysis of health state valuation data obtained using the visual analogue scale, standard gamble and time trade off methods. Thurstone’s law of comparative judgement postulates a stable relationship between ordinal and cardinal preferences, based upon the information provided by pairwise choices. McFadden proposed that this relationship could be modelled by estimating conditional logistic regression models where alternatives had been ranked. In this paper we report the estimation of such models for the Health Utilities Index Mark 2 and the SF-6D. The results are compared to the conventional regression models estimated from standard gamble data, and to the observed mean standard gamble health state valuations. For both the HUI2 and the SF-6D, the models estimated using rank data are broadly comparable to the models estimated on standard gamble data and the predictive performance of these models is close to that of the standard gamble models. Our research indicates that rank data has the potential to provide useful insights into community health state preferences. However, important questions remain

Estimating population cardinal health state valuation models from individual ordinal (rank) health state preference data

Ranking exercises have routinely been used as warm-up exercises within health state valuation surveys. Very little use has been made of the information obtained in this process. Instead, research has focussed upon the analysis of health state valuation data obtained using the visual analogue scale, standard gamble and time trade off methods. Thurstone’s law of comparative judgement postulates a stable relationship between ordinal and cardinal preferences, based upon the information provided by pairwise choices. McFadden proposed that this relationship could be modelled by estimating conditional logistic regression models where alternatives had been ranked. In this paper we report the estimation of such models for the Health Utilities Index Mark 2 and the SF-6D. The results are compared to the conventional regression models estimated from standard gamble data, and to the observed mean standard gamble health state valuations. For both the HUI2 and the SF-6D, the models estimated using rank data are broadly comparable to the models estimated on standard gamble data and the predictive performance of these models is close to that of the standard gamble models. Our research indicates that rank data has the potential to provide useful insights into community health state preferences. However, important questions remain.health state valuation; HUI-2; SF-6D

The influence of the Ratio Bias phenomenon on the elicitation of Standard Gamble utilities

This paper tests whether logically equivalent risk formats can lead to different health state utilities elicited by means of the standard gamble (SG) method. We compare SG utilities elicited when probabilities are framed in terms of frequencies with respect to 100 people in the population (i.e., X out of 100) with SG utilities elicited for frequencies with respect to 1,000 people in the population (i.e., Y out of 1,000). We found that utilities were significant higher when success and failure probabilities were framed as frequencies type “Y out of 1,000” rather than as frequencies type “X out of 100”. This framing effect, known as Ratio Bias, may have important consequences in resource allocation decisions.Framing effect, risk format, standard gamble, health state, dual-process theories.

Evidence of preference construction in a comparison of variants of the standard gamble method

An increasingly important debate has emerged around the extent to which techniques such as the standard gamble, which is used, amongst other things, to value health states, actually serve to construct respondents' preferences rather than simply elicit them. According to standard theory, the variant used should have no bearing on the numbers elicited from respondents, i.e. procedural invariance should hold. This study addresses this debate by comparing two variants of standard gamble in the valuation of health states. It is a mixed methods study that combines a quantitative comparison with the probing of respondents in order to ascertain possible reasons for the differences that emerged. Significant differences were found between variants and, furthermore, there was evidence of an ordering effect. Respondents' responses to probing suggested that they were influenced by the method of elicitation

Valuing the benefit of varicella vaccination: comparison of willingness to pay and quality-adjusted life-years

Vaccination is different from most health interventions because it is preventative, it protects against infectious disease (leading to knock-on effects), the diseases it prevents are usually acute and self-limiting, and most vaccines are given to children from whom it is very difficult to elicit preferences. Because of its unique characteristics, vaccination may possess its own specific attributes. In this paper, we estimate the average Willingness to Pay (WTP) for varicella vaccination and the Quality-Adjusted Life-Years (QALY) lost due to chickenpox using Contingent Valuation (CV), Standard Gamble and Health Utility Index Mark II (HUI2). Furthermore, we identify what attributes of vaccination are important to vaccinees and what elicitation technique can capture these components. To do this, we administered computerised interviews to a sample of parents attending primary Health Centres. Using CV we demonstrate that individuals are willing to pay more for vaccination than treatment. Furthermore, we show that prevention of work loss is an important intervention attribute for parents. On the other hand, consistent with economic theory, the elicitation techniques used to estimate QALYs (Standard Gamble and HUI2) did not capture non-health benefits. Finally, results elicited using the CV were correlated with QALYs measured through the HUI2 questionnaire

Transhiatal vs extended transthoracic resection in oesophageal carcinoma: patients' utilities and treatment preferences

To assess patients' utilities for health state outcomes after transhiatal or transthoracic oesophagectomy for oesophageal cancer and to investigate the patients' treatment preferences for either procedure. The study group consisted of 48 patients who had undergone either transhiatal or transthoracic oesophagectomy. In an interview they were presented with eight possible health states following oesophagectomy. Visual Analogue Scale and standard gamble techniques were used to measure utilities. Treatment preference for either transhiatal or transthoracic oesophagectomy was assessed. Highest scores were found for the patients' own current health state (Visual Analogue Scale: 0.77; standard gamble: 0.97). Lowest scores were elicited for the health state ‘irresectable tumour’ (Visual Analogue Scale: 0.13; standard gamble: 0.34). The Visual Analogue Scale method produced lower estimates (P<0.001) than the standard gamble method for all health states. Most patient characteristics and clinical factors did not correlate with the utilities. Ninety-five per cent of patients who underwent a transthoracic procedure and 52% of patients who underwent a transhiatal resection would prefer the transthoracic treatment. No significant associations between any patient characteristics or clinical characteristics and treatment preference were found. Utilities after transhiatal or transthoracic oesophagectomy were robust because they generally did not vary by patient or clinical characteristics. Overall, most patients preferred the transthoracic procedure

Is there a case for using Visual Analogue Scale valuations in Cost-Utility Analysis?

This paper critically reviews theoretical and empirical propositions regarding visual analogue scale (VAS) valuations of health states and their use in Cost Utility Analysis. An oft-repeated conclusion in the economic evaluation literature is the inferiority, on theoretical grounds, of VAS valuations. Common criticisms are that VAS lacks a theoretical foundation; that VAS values are not ‘choice based’; that VAS values are not consistent with utility-under-uncertainty requirements; and that context and range effects observed in VAS valuation data mean that they cannot even be considered to represent measurable value functions. We address each of the above points, critically reviewing the economic and psychometric literature relating to theories of utility and theories of utility measurement, and the welfarist and non-welfarist literature relating to social choices and QALYs. We conclude that there are strong grounds, both theoretical and empirical, for challenging the apparently emerging consensus that VAS valuations should not be used in economic assessments. The theoretical appeal of alternatives such as the standard gamble is valid only at the level of individuals, rather than social decision-making. Further, the non-welfarist foundations of CUA do not require health state valuations to be grounded in any particular theory of utility, suggesting that the selection of the appropriate valuation method should be based on empirical performance. The VAS has important advantages over rival techniques such as standard gamble and time trade-off. However, we identify a number of areas in which further research is required to establish and consolidate the potential of VAS as a valuation method