Making Composite Time Trade-Off Sensitive for Worse-than-Dead Health States

Michał Jakubczyk (), Bram Roudijk, Stefan A. Lipman and Peep Stalmeier
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Michał Jakubczyk: SGH Warsaw School of Economics
Bram Roudijk: EuroQol Research Foundation
Stefan A. Lipman: Erasmus University Rotterdam
Peep Stalmeier: Radboud University Medical Center

PharmacoEconomics, 2025, vol. 43, issue 6, No 8, 665-675

Abstract: Abstract Objective The utilities elicited with the composite time trade-off (cTTO) method for health states worse-than-dead (WTD) often correlate poorly with other severity measures, indicating a poor sensitivity of cTTO. We aimed to explore modifications to cTTO to better understand this phenomenon and identify potential improvements. Methods A total of 480 respondents completed an online TTO interview, each valuing 12 EQ-5D-5L health states. The participants were randomized into four arms, A–D. Arm A followed the standard cTTO, serving as a reference. In arm B, we removed the sorting question comparing immediate death versus 10 years in a valued state. Arm C allowed for utility values $$

Date: 2025
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DOI: 10.1007/s40273-025-01471-6

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