Abstract
ObjectiveA new methodology is introduced to scale health states on an interval scale based on similarity responses. It could be well suited for valuation of health states on specific regions of the health continuum that are problematic when applying conventional valuation techniques. These regions are the top-end, bottom-end, and states around ‘dead’.MethodsThree samples of approximately 500 respondents were recruited via an online survey. Each sample received a different judgmental task in which similarity data were elicited for the top seven health states in the dementia quality of life instrument (DQI). These states were ‘111111’ (no problems on any domain) and six others with some problems (level 2) on one domain. The tasks presented two (dyads), three (triads), or four (quads) DQI health states. Similarity data were transformed into interval-level scales with metric and non-metric multidimensional scaling algorithms. The three response tasks were assessed for their feasibility and comprehension.ResultsIn total 532, 469, and 509 respondents participated in the dyads, triads, and quads tasks respectively. After the scaling procedure, in all three response tasks, the best health state ‘111111’ was positioned at one end of the health-state continuum and state ‘111211’ was positioned at the other. The correlation between the metric scales ranged from 0.73 to 0.95, while the non-metric scales ranged from 0.76 to 1.00, indicating strong to near perfect associations. There were no apparent differences in the reported difficulty of the response tasks, but the triads had the highest number of drop-outs.DiscussionMultidimensional scaling proved to be a feasible method to scale health-state similarity data. The dyads and especially the quads response tasks warrant further investigation, as these tasks provided the best indications of respondent comprehension.
Highlights
Comprehensive and generic health-related quality of life (HRQoL) measures have been designed to capture an individual’s health status in a single value
The percentage of respondents who had one inconsistency in at least one triad was 48%. This is the first explorative study attempting to demonstrate the feasibility of eliciting similarity data on health states and scaling these data with metric and non-metric multidimensional scaling (MDS)
One of the main motives to investigate MDS was the fact that choice models suffers from dominance problems at the top and the bottom of the health-state continuum
Summary
Comprehensive and generic health-related quality of life (HRQoL) measures have been designed to capture an individual’s health status in a single value (index or weight). The most frequently used valuation techniques to derive healthstate values are the standard-gamble (SG) [3], time trade-off (TTO) [4], and the visual analogue scale (VAS) [5,6]. SG values tend to be biased by risk aversion and the SG task was often considered as too cognitively demanding [7]. TTO values incorporate time preferences in addition to health-state preferences [8]. The person trade-off method has been applied in the setting of public health evaluation, where the shortcomings of complex trade-off valuation techniques have been recognized, leading to the adoption of an easier ordinal response task [17]
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