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The Better than Dead Method: Feasibility and Interpretation of a Valuation Study

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Abstract

Background

Traditionally, the valuation of health states worse than being dead suffers from two problems: [1] the use of different elicitation methods for positive and negative values, necessitating arbitrary transformations to map negative to positive values; and [2] the inability to quantify that values are time dependent. The Better than Dead (BTD) method is a health-state valuation method where states with a certain duration are compared with being dead. It has the potential to overcome these problems.

Objectives

To test the feasibility of the BTD method to estimate values for the EQ-5D system.

Methods

A representative sample of 291 Dutch respondents (aged 18–45 years) was recruited. In a web-based questionnaire, preferences were elicited for a selection of 50 different health states with six durations between 1 and 40 years. Random-effects models were used to estimate the effects of socio-demographic and experimental variables, and to estimate values for the EQ-5D. Test–retest reliability was assessed in 41 respondents.

Results

Important determinants for BTD were a religious life stance [odds ratio 4.09 (2.00–8.36)] and the educational level. The fastest respondents more often preferred health-state scenarios to being dead and had lower test–retest reliability (0.45 versus 0.77 and 0.84 for fast, medium and slow response times, respectively). The results showed a small number of so-called maximal endurable time states.

Conclusion

Valuating health states using the BTD method is feasible and reliable. Further research should explore how the experimental setting modifies how values depend on time.

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Acknowledgments

P.S. coordinated the study, designed the methodology and performed the data collection. R.D. helped with statistical design and analysis. R.H. drafted the paper and performed all data analysis. M.O. participated in setting up the study design. All authors contributed in redrafting of the paper, and all authors read and approved the final manuscript.

Disclosure

Financial support for this study was provided by a grant (number 152002034) from the Netherlands Organization for Health Research and Development (ZonMw) and the EuroQol group. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report.

Author information

Authors and Affiliations

  1. Department for Health Evidence, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands

    R. A. van Hoorn, A. R. T. Donders & P. F. M. Stalmeier

  2. Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands

    M. Oppe

Authors
  1. R. A. van Hoorn
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  2. A. R. T. Donders
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  3. M. Oppe
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  4. P. F. M. Stalmeier
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Corresponding author

Correspondence to R. A. van Hoorn.

Electronic Supplementary Material

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Appendix

Appendix

See Table 3.

Table 3 Quality-adjusted life-years (QALYs) for all 50 health states by duration, using the full model
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van Hoorn, R.A., Donders, A.R.T., Oppe, M. et al. The Better than Dead Method: Feasibility and Interpretation of a Valuation Study. PharmacoEconomics 32, 789–799 (2014). https://doi.org/10.1007/s40273-014-0168-4

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