Health-state valuation using discrete choice models

Abstract

The aim of this thesis was to investigate specific problems associated with preference-based measures (values) of health states and with the methodology used to derive health-state values. The first chapter covers the changes in phrasing and differences in measurement methods in the EQ-5D instrument after the five-level version was introduced alongside the conventional three-level version. Specifically, a head-to-head comparison of the values elicited from a large sample showed slight differences between the two versions. The study described in the second chapter was motivated by the fact that most instruments do not take into account the interactions of distinct health attributes (reduction in perceived health status may intensify if two different health problems interact). Our study revealed that the inclusion of interactions between various EQ-5D health aspects leads to different values for health states. The third chapter shows that people with experience of disease tend to value health states differently, or assign importance to certain health attributes differently than healthy respondents do. The fourth chapter presents a separate discrete choice study that we conducted to determine the importance of criteria regarding new medical treatments. We found four criteria to be important, based on preferences of the general population and patients: health gains, patient's age, patient's initial health condition, and cause of the disease. In the fifth chapter we present an eye-tracking study, which proved to support a basic assumption in health-state measurement: that respondents pay attention to all elements of the health state description and do not disregard information