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Chained time trade-off and standard gamble methods

Applications in oesophageal cancer

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The European Journal of Health Economics, formerly: HEPAC Aims and scope Submit manuscript

Abstract

It may be difficult to value palliative health states using health state valuation methods such as the time trade-off (TTO) and standard gamble (SG) where health states are traditionally valued relative to perfect/good health and death. Chained methods have been developed to help in this context. However, few studies have compared the values produced by chained TTO and SG methods. To address this issue, a study was conducted to measure the health state values associated with oesophageal cancer using chained TTO and SG techniques. The methods were found to be acceptable amongst the sample respondents, who had previously been treated for oesophageal cancer. There were no significant differences between the health state values produced by the TTO and the SG methods. Within each method, however, there were significant differences between the health states valued. It is concluded that the use of health state valuation techniques such as the TTO and SG is feasible amongst people with a history of oesophageal cancer.

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Acknowledgements

The study was funded by the National Health Service Health Technology Assessment Programme. The authors would like to thank Pauline Potts for her assistance in processing the data and the patients for their contribution to the study.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Public Health, School of Population and Health Sciences, University of Newcastle, Newcastle upon Tyne, UK

    Paul McNamee

  2. Centre for Health Services Research, School of Population and Health Sciences, University of Newcastle, Newcastle upon Tyne, UK

    Sharon Glendinning, Nick Steen & John Bond

  3. Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK

    Jonathan Shenfine & S. Michael Griffin

  4. Health Economics Research Unit, Institute of Applied Health Sciences, University Medical Buildings, Foresterhill, Aberdeen, AB25 2ZD, UK

    Paul McNamee

Authors
  1. Paul McNamee
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  2. Sharon Glendinning
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  3. Jonathan Shenfine
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  4. Nick Steen
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  5. S. Michael Griffin
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  6. John Bond
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Corresponding author

Correspondence to Paul McNamee.

Additional information

Financial support for this study was provided by the National Health Service Technology Assessment (NHS HTA) Programme, project number 96/06/07. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing and publishing the paper.

Appendix 1: Health and treatment descriptions used in interviews

Appendix 1: Health and treatment descriptions used in interviews

Good health

  1. 1.

    You lead an active life and find work and other interests/activities rewarding.

  2. 2.

    You have good relations with family and friends.

  3. 3.

    You have a healthy lifestyle in terms of diet and leisure activities.

  4. 4.

    You have a positive approach to life and rarely feel anxious or depressed.

  5. 5.

    You have no health problems which cause pain or discomfort.

  6. 6.

    You welcome new challenges and feel optimistic about the future in both work and personal life.

Health state 1

  1. 1.

    You can eat all sorts of raw and cooked food.

  2. 2.

    You eat your usual amount of food.

  3. 3.

    You do not have any problems carrying out your usual daily activities (these may include visiting friends/family, housework, leisure activities, going out for meals).

  4. 4.

    You may have one of the following symptoms: pain, shortness of breath.

Health state 2

  1. 1.

    You find it difficult to eat hard, solid foods.

  2. 2.

    You eat less.

  3. 3.

    You have some problems carrying out your usual daily activities.

  4. 4.

    You may have one or more of the following symptoms: pain, shortness of breath, vomiting and regurgitation.

Health state 3

  1. 1.

    You cannot eat any solid foods.

  2. 2.

    You eat a lot less.

  3. 3.

    You have frequent problems carrying out your usual daily activities.

  4. 4.

    You will have two or more of the following symptoms: pain, shortness of breath, vomiting and regurgitation, weak/sore muscles, loss of taste, bad breath.

Health state 4

  1. 1.

    You are limited to a completely liquid diet.

  2. 2.

    You are not able to eat or drink much before feeling full.

  3. 3.

    You have a lot of problems carrying out your usual daily activities.

  4. 4.

    You will have three or more of the following symptoms: pain, shortness of breath, vomiting and regurgitation, weak/sore muscles, loss of taste, bad breath.

Health state 5

  1. 1.

    You cannot swallow at all.

  2. 2.

    You are not able to eat or drink anything.

  3. 3.

    You are not able to carry out your usual daily activities.

  4. 4.

    You will have four or more of the following symptoms: pain, shortness of breath, vomiting and regurgitation, weak/sore muscles, loss of taste, bad breath, dry mouth, drooling saliva, persistent cough and wheeze.

Treatment 1

You have frequent problems carrying out your usual daily activities (these may include visiting friends/family, housework, leisure activities, going out for meals). You are about to receive treatment which involves:

  1. 1.

    Making one trip to hospital

  2. 2.

    Being admitted to hospital for two nights

  3. 3.

    Having moderate pain for a few days after treatment

After treatment you are less likely to have problems carrying out your daily activities.

Treatment 2 (identical to treatment 1 apart from the following:)

  1. 1.

    Making one trip to hospital

  2. 2.

    Not being admitted to hospital

  3. 3.

    Having moderate pain for 2 weeks after treatment

Treatment 3 (identical to treatment 1 apart from the following:)

  1. 1.

    Making two or three trips to hospital

  2. 2.

    Being admitted to hospital for one night on each trip

  3. 3.

    Having mild pain for a few days after each treatment

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McNamee, P., Glendinning, S., Shenfine, J. et al. Chained time trade-off and standard gamble methods. HEPAC 5, 81–86 (2004). https://doi.org/10.1007/s10198-003-0217-y

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  • DOI: https://doi.org/10.1007/s10198-003-0217-y

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