cadth 2015 e3 eq5 d
TRANSCRIPT
Using a Discrete Choice Experiment to Value the
EQ-5D-5L in Canada Nick Bansback
Assistant ProfessorSchool of Population and Public Health, University of British
ColumbiaCIHR New Investigator
Conflict of interest
• Member of the EuroQol group
• No conflicts related to this presentation
National Health State Valuation StudiesWe want:
An algorithm for a descriptive health classification system
That reflect values from individuals that engage and
understand the task
From a representative sample of general
population
How many people engage and understand the TTO?
• We excluded 136 (11%) from the TTO analysis:• Illogical responses (e.g. value some pain better than no
pain)• Implausible responses (e.g. value mild health states as
worse than dead)• Untrustworthy responses (e.g. value a variety of health
states the same)
How many people engage and understand the TTO?
Engel L. et al. Exclusion Criteria in National Health State Valuation Studies: a Systematic Review
But did the rest really understand and engage?
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N
TTO
Values for health state 55555
N
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Values for all health states0
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TTO
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N
TTO
Impact of exclusions on representativeness• In the wider literature, excluded persons
tend to be older, less educated and sicker1
• Similar findings in our TTO study
• Impact of exclusions on values varies between studies1
• Small differences (larger at more severe health states) found in our TTO study
→ the TTO task seems to lead to exclusions that might influence the representativeness and numbers in National Health State Valuation Studies
1. Engel L. et al. Exclusion Criteria in National Health State Valuation Studies: a Systematic Review
Discrete choice experiment with a duration attribute (DCEtto)
Health State A Health State B
Some problems in walking about
No problems in walking about
No problems with self-care Some problems with self-care
Some problems with performing my usual activities
Some problems with performing my usual activities
Moderate pain or discomfort No pain or discomfort
Not anxious or depressed Extremely anxious or depressed
Live for 10 years Live for 7 years
Choose A or B
Health State A Health State B
Some problems in walking about
No problems in walking about
No problems with self-care No problems with self-care
Some problems with performing my usual activities
No problems with performing my usual activities
Moderate pain or discomfort No pain or discomfort
Not anxious or depressed Not anxious or depressed
Live for 10 years Live for t years
Vary t until indifferent between A and B
DCEtto Requires if health state A is preferred to B and not the degree by which A is preferred to B
TTO DCEtto
Previous research in DCEtto
• Simpler (fewer drop-outs)• Enables incorporation of all respondents,
increasing power and representativenessCognition•Included with no change in task or arbitrary transformation
States worse than dead
•DCEs rooted in economic theory (RUT)Theory
•Quick to complete•Can be implemented on the web (cheaper)Practical
Bansback, et al. "Using a discrete choice experiment to estimate health state utility values." Journal of health economics 31.1 (2012): 306-318.Bansback, et al. "Testing a discrete choice experiment including duration to value health states for large descriptive systems: Addressing design and sampling issues." Social Science & Medicine 114 (2014): 38-48.
Canadian EQ-5D 5L study
• Alongside the TTO, participants also completed between 7 and 9 DCEtto tasks (in 7 tasks duration was equal between options)• A total of 252 DCE unique pairs were
valued – created using D-efficient designs• 1107 respondents – 19926 observations• Modelled using conditional logit model,
interacting duration with each level of each EQ-5D dimension
Differences in distribution of values
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N
TTO
Values for health state 55555
N
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Values for all health states
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N
DCEtto TTO
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N
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N
DCEtto TTO
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DCEtto TTO
Differences in average values
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TTO DCEtto
←Better health states Worse health states→
Util
ity v
alue
s
Impact of excluded respondents from TTO
←Better health states Worse health states→
Util
ity v
alue
s
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2134
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2144
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DCEtto exclusions DCEtto all
Limitations
• Unclear whether the DCEtto really is simpler• Harder to test whether respondents have
engaged and understood the task• Gives lower values than TTO – but these
are not directly valued - difficult to know if they are real• …All questions currently being
investigated in studies by our team and others