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Determinants of time trade-off valuations for EQ-5D-5L health states: data from the Canadian EQ-5D-5L valuation study

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Previous studies suggest that population subgroups have different perceptions of health, as well as different preferences for hypothetical health states.


To identify determinants of health states preferences elicited using time trade-off (TTO) for the 5-level EQ-5D questionnaire (EQ-5D-5L) in Canada.


Data were from the Canadian EQ-5D-5L Valuation Study, which took place in Edmonton, Hamilton, Montreal, and Vancouver. Each respondent valued 10 of 86 hypothetical health states during an in-person interview using a computer-based TTO exercise. The TTO scores were the dependent variable and explanatory variables including age, sex, marital status, education, employment, annual household income, ethnicity, country of birth, dwelling, study site, health literacy, number of chronic conditions, previous experience with illness, and self-rated health.


Average [standard deviation (SD)] age of respondents (N = 1209) was 48 (17) years, and 45 % were male. In multivariable linear regression models with random effects, adjusted for severity of health states and inconsistencies in valuations, older age [unstandardized regression coefficient (β) = −0.077], male sex (β = 0.042), being married (β = 0.069), and urban dwelling (β = −0.055) were significantly associated with health states scores. Additionally, participants from Edmonton (β = −0.124) and Vancouver (β = −0.156), but not those from Hamilton, had significantly lower TTO scores than those from Montreal.


Socio-demographic characteristics were the main determinants of preferences for EQ-5D-5L health states in this study. Interestingly, preferences were significantly lower in western Canadian cities compared to eastern ones, bringing into question whether a single preference algorithm is suitable for use in all parts of Canada.

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This project was supported by an operating Grant from the Canadian Institutes for Health Research (#MOP 111076) and funding support from the EuroQol Research Foundation. Feng Xie and Eleanor Pullenayegum are supported by Canadian Institutes of Health Research New Investigator Awards (2012–2017). Jeffrey Johnson is a Senior Health Scholar with Alberta Innovates Health Solutions.

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Correspondence to Jeffrey A. Johnson.

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All authors have no conflicts of interest to declare.

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The Health Research Ethics Boards at the Universities of Alberta, McMaster, and British Columbia and the Ethics Board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal approved the data collection protocols and survey instruments.

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Informed consent was obtained from all individual participants included in the study.

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Sayah, F.A., Bansback, N., Bryan, S. et al. Determinants of time trade-off valuations for EQ-5D-5L health states: data from the Canadian EQ-5D-5L valuation study. Qual Life Res 25, 1679–1685 (2016).

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