Abstract
BackgroundPerson trade-off (PTO) elicitations yield different values than standard utility measures, such as time trade-off (TTO) elicitations. Some people believe this difference arises because the PTO captures the importance of distributive principles other than maximizing treatment benefits. We conducted a qualitative study to determine whether people mention considerations related to distributive principles other than QALY-maximization more often in PTO elicitations than in TTO elicitations and whether this could account for the empirical differences.Methods64 members of the general public were randomized to one of three different face-to-face interviews, thinking aloud as they responded to TTO and PTO elicitations. Participants responded to a TTO followed by a PTO elicitation within contexts that compared either: 1) two life-saving treatments; 2) two cure treatments; or 3) a life-saving treatment versus a cure treatment.ResultsWhen people were asked to choose between life-saving treatments, non-maximizing principles were more common with the PTO than the TTO task. Only 5% of participants considered non-maximizing principles as they responded to the TTO elicitation compared to 68% of participants who did so when responding to the PTO elicitation. Non-maximizing principles that emerged included importance of equality of life and a desire to avoid discrimination. However, these principles were less common in the other two contexts. Regardless of context, though, participants were significantly more likely to respond from a societal perspective with the PTO compared to the TTO elicitation.ConclusionWhen lives are at stake, within the context of a PTO elicitation, people are more likely to consider non-maximizing principles, including the importance of equal access to a life-saving treatment, avoiding prejudice or discrimination, and in rare cases giving treatment priority based purely on the position of being worse-off.
Highlights
Person trade-off (PTO) elicitations yield different values than standard utility measures, such as time trade-off (TTO) elicitations
After the TTO elicitation, participants responded to PTO elicitations in which we asked them to imagine being "on a panel of experts trying to decide between two different medical treatments." We described two alternative treatment programs and asked the participants, "Which would you choose or are the choices good?" Participants responded to at least two PTO scenarios in which they were asked to choose between: 1) curing a life-threatening infection in previously health people versus curing a life-threatening infection in patients with paraplegia; 2) curing a lifethreatening infection in previously healthy people versus curing patients with a spinal cord injury to prevent paraplegia; or 3) curing patients of severe shortness of breath versus curing patients of moderate leg pain
We found no significant differences between actual PTO indifference points and those predicted from TTO responses
Summary
Person trade-off (PTO) elicitations yield different values than standard utility measures, such as time trade-off (TTO) elicitations. Some people believe this difference arises because the PTO captures the importance of distributive principles other than maximizing treatment benefits. Public preferences, as measured by PTO elicitations, place nearly equal value on saving the lives of healthy people and people with paraplegia [22,23,24]. In traditional preference measurement methods, such as the time trade-off (TTO) and standard gamble (SG), people are asked, typically from a personal perspective, to state their preference for a health state by imagining they are in that health state but could be returned to perfect health if they lived fewer years (TTO) or won a gamble (SG). Respondents might be asked how many patients would need to be cured of moderate leg pain to be good as curing 100 patients of severe shortness of breath
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