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Thirty down, only ten to go?! Awareness and influence of a 10-year time frame in TTO

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Abstract

Background

Time trade-off (TTO) exercises typically present respondents with a limited time horizon, for example 10 years, thus implicitly considerably reducing remaining life expectancy for the average respondent. It is unclear how this affects health state valuations.

Aim

The aim of the study is to investigate how awareness of the reduced life span implied by a 10-year TTO affects health state valuations, using an experimental design.

Methods

Two Web-based questionnaires (Q1 and Q2) were administered in a sample representative of the Dutch population. Both questionnaires contained three 10-year TTO exercises valuing three distinct health states, specified using the EQ-5D. Q1 used a TTO instruction not explicitly emphasizing the fact that remaining life expectancy was reduced to 10 years, while in Q2 respondents were explicitly made aware of this fact by emphasizing their implied age of death. Respondents answering Q1 were asked retrospectively whether they had been aware of their reduced life span due to the 10-year TTO.

Results

In total, 656 respondents completed the questionnaires (Q1: 339 and Q2: 317). The average age of the respondents was 43 years and 51 % of respondents were male. The average numbers of years traded off for the respondents of Q1 were for TTO1 0.443, TTO2 0.552, and TTO3 2.083 years. For the respondents of Q2, these averages were lower, i.e., TTO1 0.401 (p = 0.085 vs. Q1), TTO2: 0.546 (p = 0.036 vs. Q1), and TTO3: 1.467 years (p = 0.000 vs. Q1). Fifty-seven percent of respondents in Q1 confirmed that they were aware of the reduced life span. This spontaneous awareness had a limited and mixed influence on results. The generalized negative binomial regression analysis, explaining the time traded off showed that age, subjective life expectancy, and questionnaire Q2 (vs. Q1) were negatively associated with the years traded off, whereas education and worse health states in the TTO exercise had a significant positive impact on the years traded off. The probit model investigating the impact on the willingness to trade showed that age (−), education (+), subjective life expectancy (−), questionnaire Q2 versus Q1 (−), the interaction between Q2 and male gender (+), and worse health states in the TTO exercise (+) had a significant impact on the willingness to trade.

Conclusion

These findings emphasize the importance of expected and implied life expectancy in TTOs.

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Notes

  1. These health states are described as follows:

    21211: I have some problems walking about, I have no problems with self-care, I have some problems with performing my usual activities, I have no pain or discomfort, I am not anxious or depressed;

    22221: I have some problems walking about, I have some problems with self-care, I have some problems with performing my usual activities, I have moderate pain or discomfort, I am not anxious or depressed;

    33312: I am confined to bed, I am unable to wash or dress myself, I am unable to perform my usual activities, I have no pain or discomfort, I am moderately anxious or depressed.

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Acknowledgments

We are grateful to the attendees of the ECHE Conference 2008 in Rome for useful comments on an earlier version of this paper. The usual disclaimer applies.

Conflict of interest

The authors have no conflict of interest.

Author information

Authors and Affiliations

  1. Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands

    F. E. van Nooten & W. B. F. Brouwer

  2. VU University Amsterdam, Amsterdam, The Netherlands

    X. Koolman

  3. Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands

    J. J. V. Busschbach

  4. Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands

    W. B. F. Brouwer

Authors
  1. F. E. van Nooten
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  2. X. Koolman
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  3. J. J. V. Busschbach
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  4. W. B. F. Brouwer
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Corresponding author

Correspondence to W. B. F. Brouwer.

Appendix: Questionnaire

Appendix: Questionnaire

TTO in Q1 and Q2

You can choose between Option A and Option B. In Option A, you will live 10 years in a stable but not perfect health state, after which you will die. In Option B, you will live less than 10 years but in perfect health, after which you will die.

Option A

Option B

Living 10 more years in the following health state:

Living … more years in perfect health

Some problems in walking about

 

No problems with self-care

 

Some problems with performing usual activities

 

No pain or discomfort

 

Not anxious or depressed

 

We would first like you to indicate which age you would reach if you had 10 years left to live (like in Option A): … years

[This question was only posed in Q2, not in Q1, which was otherwise identical]

You can choose for either Option A or Option B.

How many years in perfect health would have to be minimally provided in Option B for you to choose Option B?

Please note: you can only indicate a number less than 10 years.

□ I choose Option B if I can live a minimum of … years in perfect health.

□ I don’t want to give up any time and will always choose Option A

Question in Q1 to ask about the 10 year awareness

Before, you had to make three choices between living in an imperfect health state for 10 years and living in perfect health for a shorter period. Every time you were asked to consider that after the maximum period of 10 years, you would die. Such instructions are often used in this type of research, but will probably not coincide with your own expectations. We would like to ask you some questions about this.

  • 1. Did you consider what age you would achieve when you would have no more than 10 years to live, while answering the questions?

    □ Yes

    □ No

Question regarding the expected age of death

Often people have some expectation regarding what age they will reach themselves in life.

What age do you yourself expect to reach? … years

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van Nooten, F.E., Koolman, X., Busschbach, J.J.V. et al. Thirty down, only ten to go?! Awareness and influence of a 10-year time frame in TTO. Qual Life Res 23, 377–384 (2014). https://doi.org/10.1007/s11136-013-0495-5

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  • DOI: https://doi.org/10.1007/s11136-013-0495-5

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