Abstract
ObjectiveThe aim of this study was to compare online, unsupervised and face-to-face (F2F), supervised valuation of EQ-5D-5L health states using composite time trade-off (cTTO) tasks.MethodsThe official EuroQol experimental design and valuation protocol for the EQ-5D-5L of 86 health states were implemented in interviewer-assisted, F2F and unsupervised, online studies. Validity of preferences was assessed using prevalence of inconsistent valuations and expected patterns of TTO values. Respondent task engagement was measured using number of trade-offs and time per task. Trading patterns such as better-than-dead only was compared between modes. Value sets were generated using linear regression with a random intercept (RILR). Value set characteristics such as range of scale and dimension ranking were evaluated between modes.ResultsFive hundred one online and 1,134 F2F respondents completed the surveys. Mean elicited TTO values were higher online than F2F when compared by health state severity. Compared to F2F, a larger proportion of online respondents did not assign the poorest EQ-5D-5L health state (i.e., 55555) the lowest TTO value ([Online] 41.3% [F2F] 12.2%) (p < 0.001). A higher percentage of online cTTO tasks were completed in 3 trade-offs or fewer ([Online] 15.8% [F2F] 3.7%), (p < 0.001). When modeled using the RILR, the F2F range of scale was larger than online ([Online] 0.600 [F2F] 1.307) and the respective dimension rankings differed.ConclusionsCompared to F2F data, TTO tasks conducted online had more inconsistencies and decreased engagement, which contributed to compromised data quality. This study illustrates the challenges of conducting online valuation studies using the TTO approach.
Highlights
Valuation studies of measures of health, e.g., the EQ-5D, are traditionally conducted in-person with trained interviewers
The online study was conducted by SurveyEngine, a company specializing in preference elicitation, and used an online platform modeled after the EuroQol Valuation Technology (EQ-VT)
The online sample reported poorer understanding of the time trade-off (TTO) tasks, was less engaged with the tasks, and had poorer data validity compared to F2F Full and F2F Valid samples
Summary
Valuation studies of measures of health, e.g., the EQ-5D, are traditionally conducted in-person with trained interviewers. This face-to-face elicitation of preferences has been refined and may be considered the de facto standard to ensure respondent attendance/engagement with an understanding. Quality of Life Research (2021) 30:1433–1444 of the task. Such a process is resource and timeintensive [1,2,3,4]. Additional shortcomings of in-person studies include potential social desirability bias in respondent answers, difficulty recruiting certain populations, and respondent unwillingness to answer sensitive questions, which may contribute to missing data, increase bias, and limit generalizability [3, 5]. Selection biases exist online, different from those which affect in-person data collection (e.g., differential internet access among segments of the population) [4, 6]
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