Abstract
Background
Recent research suggests that the value of health states may depend on their duration, implying a more complex relationship between quality and quantity of life than the standard linear relationship assumed in the quality-adjusted life years (QALY) model.
Objective
This study models how duration affects the value of health states, using discrete choice data.
Methods
A study was conducted comprising health profiles including various durations. Health states were described with the EQ-5D. Duration was introduced as a sixth domain with six levels (1, 5, 10, 15, 30, 50 years). Sixty pairs of health profiles were selected, applying a Bayesian approach. Two hundred eight university students self-completed the computerized response tasks. Data were analyzed with a conditional logistic regression model.
Results
There is clear evidence for non-linear values for duration, that is, preferences for duration are more accurately described by a logarithmic function.
Conclusions
In discrete choice experiments using health states with different durations, these data present the first evidence for decreasing marginal utility for duration. Our results suggest that refinement of the standard QALY framework may be needed for states with a long duration.
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Acknowledgments
This work was partially based on our inspiring discussions and reflections during several meetings of the EuroQol Valuation Task Force. Therefore, we wish to express our thanks in particular to Frank de Charro, Nancy Devlin, Ben van Hout, Paul Kind, and David Parkin. A special thank you to Elly Stolk and Mark Oppe for their precious contributions to the study design and data collection. We thank also Eva de Vries, Anke Naaborgh, and Mark Huijsman for their assistance in the data collection, and Roberta Ciampichini for her assistance in data management. Everyone who contributed significantly to the work has been listed in the acknowledgements. This research was made possible by a grant provided by the EuroQoL Group. It was presented at the ISPOR 13th Annual European Congress in Prague, November 2010, and was a candidate for receiving the best poster research presentation award.
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The authors of this manuscript have no conflict of interest to declare.
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Scalone, L., Stalmeier, P.F.M., Milani, S. et al. Values for health states with different life durations. Eur J Health Econ 16, 917–925 (2015). https://doi.org/10.1007/s10198-014-0634-0
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DOI: https://doi.org/10.1007/s10198-014-0634-0