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Censoring in the time trade-off valuation of worse-than-dead EQ-5D-5L health states: can a time-based willingness-to-accept question be the solution?

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Abstract

Purpose

The left censoring of values at −1 by design of the composite time trade-off (cTTO) tasks leads to excessive amount of −1 values in some EQ-5D-5L valuation studies. This study aimed to investigate whether a time-based willingness-to-accept (tWTA) question can be used to elicit values lower than −1 and improve the estimation of EQ-5D-5L values.

Methods

At the end of each cTTO task in the Taiwanese EQ-5D-5L valuation study, if the value of the health state was indicated to be lower than −1, a tWTA question eliciting the indifference point between a hypothetical life (i.e. x number of years in full health followed by 10 years in the health state) and immediate death was used to estimate its uncensored value. We compared the statistical characteristics of the censored and uncensored data.

Results

Four hundred and twenty-nine of 1,000 respondents were offered the tWTA question in a total of 1,071 cTTO tasks. In 79.55% of those tasks, indifference was not reached. Spearman’s correlation with level summary score was −0.41 and −0.40 for negative uncensored and censored data, respectively. The logical inconsistency rates of the uncensored and censored data were 0.88% vs. 0.29%, respectively. Modelling of the uncensored data resulted in coefficients with greater uncertainty and much lower predictions.

Conclusions

The elicitation of values lower than −1 using a tWTA question that grants more time for trading seems not a promising solution to the value censoring of the cTTO tasks. Other strategies for valuation of very poor health states should be explored.

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Data availability

The data that support the findings of this study are available from the corresponding author, Lin, H.W., upon reasonable request.

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Funding

This study was supported by the EuroQol Research Foundation (EQ Project 2016440) to HWL, Center for Drug Evaluation (#10542652) to HWL, the Ministry of Science and Technology, Taiwan (NSC102-2320-B-039–007, MOST109-2320-B-039–023) to HWL, and the National Health Research Institute, Taiwan (Grant NHRI-EX103-10318PC, NHRI-EX104-10318PC, NHRI-EX105-10318PC, and NHRI-EX106-10318PC), China Medical University (CMU) (CMU108-Z-7, CMU109-Z-07, CMU110-Z-07, CMU109-MF-40) to HWL in the preparation and implementation stage in the past few years. The listed funding agencies had no role in the study implementation, analysis or interpretation of data, or preparation, review or approval of the manuscript. We would like to appreciate all the assistances, researchers and experts in this project.

Author information

Authors and Affiliations

  1. Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Meixia Liao & Nan Luo

  2. Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway

    Kim Rand

  3. Maths in Health B.V., Rotterdam, The Netherlands

    Kim Rand

  4. Health Services Management Department, Guizhou Medical University, Guiyang, China

    Zhihao Yang

  5. Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Chien-Ning Hsu

  6. School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan

    Chien-Ning Hsu

  7. School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, Taichung, Taiwan

    Hsiang-Wen Lin

  8. Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan

    Hsiang-Wen Lin

  9. Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA

    Hsiang-Wen Lin

Authors
  1. Meixia Liao
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  2. Kim Rand
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  3. Zhihao Yang
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  4. Chien-Ning Hsu
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  5. Hsiang-Wen Lin
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  6. Nan Luo
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Contributions

All authors contributed to the study conception and design. Data analysis and interpretation were performed by ML and NL. The first draft of the manuscript was written by ML and NL and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Hsiang-Wen Lin or Nan Luo.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study received ethics approval from the China Medical University & Hospital Research Ethics Committee (CMUH105-REC1-111).

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Not applicable.

Consent to participate

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

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Liao, M., Rand, K., Yang, Z. et al. Censoring in the time trade-off valuation of worse-than-dead EQ-5D-5L health states: can a time-based willingness-to-accept question be the solution?. Qual Life Res 32, 1165–1174 (2023). https://doi.org/10.1007/s11136-022-03329-2

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