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Complex Valuation: Applying Ideas from the Complex Intervention Framework to Valuation of a New Measure for End-of-Life Care

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Abstract

Background

The UK Medical Research Council approach to evaluating complex interventions moves through development, feasibility, piloting, evaluation and implementation in an iterative manner. This approach might be useful as a conceptual process underlying complex valuation tasks.

Objective

The objective of the study was to explore the applicability of such a framework using a single case study (valuing the ICECAP-Supportive Care Measure) and considering three key uncertainties: the number of response categories for the measure; experimental design; and the potential for using slightly different variants of the measure with the same value set.

Methods

Three on-line pilot studies (n = 204, n = 100, n = 102) were undertaken during 2012 and 2013 with adults from the UK general population. Each used variants of discrete choice and best-worst scaling tasks; respondents were randomly allocated to different groups to allow exploration of the number of levels for the instrument (four or five), optimal experimental design and the values for alternative wording around prognosis. Conditional logit regression models were used in the analysis and variance scale factors were explored.

Results

The five-level version of the measure seemed to result in simplifying heuristics. Plotting the variance scale factors suggested that best-worst scaling answers were approximately four times more consistent than the discrete choice answers. The likelihood ratio test indicated there was virtually no difference in values between the differently worded versions.

Conclusion

Rigorous piloting can improve the design of valuation studies. Thinking in terms of a ‘complex valuation framework’ may emphasise the importance of conducting and funding such rigorous pilots.

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Acknowledgments

This work was supported by the European Research Council (261098 EconEndLife). The work was conducted whilst Joanna Coast was based at the University of Birmingham. We thank the members of the EconEndLife advisory group and all research participants. We also thank Raymond Oppong and participants at the International Choice Modelling Conference, Sydney, July 2013 and the iHEA congress, Sydney, 2013 for comments on earlier versions of the paper.

Author contributions

All authors contributed to the design of the study, interpretation of data and final approval. JC additionally conceived the overall study and wrote the first draft of the paper. TNF additionally conceived the experimental design and analysis plan for the DCE/BWS, acquired and analysed the data, and contributed to revising the paper. EH additionally acquired and analysed the data and contributed to revising the paper. PK additionally oversaw the ethical aspects of the study and contributed to revising the paper.

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Authors and Affiliations

  1. School of Social and Community Medicine , University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK

    Joanna Coast & Philip Kinghorn

  2. Institute for Choice, University of South Australia, Adelaide, Australia

    Elisabeth Huynh

  3. TF Choices Ltd, Nottingham, UK

    Terry Flynn

Authors
  1. Joanna Coast
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  2. Elisabeth Huynh
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  3. Philip Kinghorn
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  4. Terry Flynn
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Corresponding author

Correspondence to Joanna Coast.

Ethics declarations

EH, TNF and PK declare that they have no conflict of interest. JC received a grant for the work from the European Research Council (261098 EconEndLife).

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Coast, J., Huynh, E., Kinghorn, P. et al. Complex Valuation: Applying Ideas from the Complex Intervention Framework to Valuation of a New Measure for End-of-Life Care. PharmacoEconomics 34, 499–508 (2016). https://doi.org/10.1007/s40273-015-0365-9

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  • DOI: https://doi.org/10.1007/s40273-015-0365-9

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