Time Trade-Off and Ranking Exercises Are Sensitive to Different Dimensions of EQ-5D Health States

Abstract

BackgroundOne method suggested for creating preference-based tariffs for the new five-level EuroQol five-dimensional (EQ-5D) questionnaire is combining time trade-off (TTO) and discrete choice exercises. Rank values from previous valuation studies can be used as proxies for discrete choice exercises. This study examined rank and TTO data to determine whether the methods differ in sensitivity to the EQ-5D questionnaire dimensions. MethodsWe used rank and TTO data for 42 EQ-5D questionnaire health states from the US and UK three-level EQ-5D questionnaire valuation studies, extracting overall ranks of mean TTO and mean rank values, ranging from 1 (best) to 42 (worst). We identified pairs of health states with reversed overall ranks between TTO and rank data and regressed overall rank differences (TTO – ranking) on dummy variables representing impairments on EQ-5D questionnaire dimensions. ResultsForty-three (US) and 41 (UK) health state pairs displayed reversed rank order. Both US and UK regression models on rank differences indicated that respondents rated impairments involving pain/discomfort and anxiety/depression as relatively worse in TTO than in the ranking task. DiscussionDifferent dimension sensitivity between TTO and ranking methods suggests that combining them could lead to inconsistent tariffs. Differences could be caused by respondents focusing on the first presented dimensions when ranking states or could be related to the longest endurable time for health states involving pain/discomfort or anxiety/depression. The observed differences call into question which method best represents the preferences of the population.