Beyond 10-year lead-times in EQ-5D-5L: leveraging alternative lead-times in willingness-to-accept questions to capture preferences for worse-than-dead states and their implication

Jen-Yu Amy Chang, Chien-Ning Hsu, Juan Manuel Ramos-Goñi, Nan Luo, Hsiang-Wen Lin () and Fang-Ju Lin ()
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Jen-Yu Amy Chang: University of Sheffield
Chien-Ning Hsu: Kaohsiung Chang Gung Memorial Hospital
Juan Manuel Ramos-Goñi: Maths in Health B.V.
Nan Luo: National University of Singapore
Hsiang-Wen Lin: China Medical University
Fang-Ju Lin: National Taiwan University

The European Journal of Health Economics, 2024, vol. 25, issue 6, No 10, 1055 pages

Abstract: Abstract Background A fixed 10-year lead-time in composite time-trade-off (C-TTO) tasks might compromise the precision of utility values below − 1. This study explored how alternative lead-times (ALTs) influence EQ-5D-5L value sets and their implications in economic evaluations. Methods Leveraging data from Taiwan’s EQ-5D-5L valuation and capitalizing on its exploratory willingness-to-accept question, we explored participants’ quantification of “worse-than-dead (WTD)” health states with ALTs up to 50 years. We then derived alternative value sets incorporating these ALTs through interval regression and compared them against those from conventional models. To evaluate their impact on health change valuation, we simulated utility differences for all possible EQ-5D-5L health-state-pairs using each value set. Results With a salient floor effect observed in the C-TTO values, the model with ALT led to a wider range of predicted utilities ( – 2.3897 ~ 1), compared with those of conventional models (generalized least squares (GLS): – 0.7773 ~ 1; Tobit-GLS: – 0.9583 ~ 1). Compared to the Tobit-GLS model, the model with ALT increased the numerical distance in 80% of health-state-pairs, with 11% decreasing and 9% altering direction (e.g., positive to negative) in utility differences. Conclusions While ALTs offer insights into patient preferences, their integration into economic evaluations might require rescaling. Future research should prioritize advanced rescaling methods or enhanced elicitation strategies for populations with substantial censoring. This is pivotal for improving the elicitation of extreme WTD states and accurately discerning the relative distances between health states. Countries developing EQ-5D-5L value sets should consider pilot studies and incorporating region-specific questions on social determinants, especially where pronounced floor effects are suspected.

Keywords: EQ-5D-5L; Composite time-trade off; Lead-time; Interval regression; Worse-than-dead states (search for similar items in EconPapers)
Date: 2024
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DOI: 10.1007/s10198-023-01642-2

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