Health Value Research Articles

Large scale OECD health valuation study to estimate the economic benefits of chemical regulation

Abstract Chemical regulation aims at protecting human health and the environment from the risks of chemicals, while recognizing the economic importance of the use of chemicals. Assessment of the societal impacts of chemical regulation and different policy options requires information on both costs and benefits. So far, regulators assessing chemicals regulations has not had access to high quality and internationally comparable data on the full monetary benefit of reducing health and environmental risk. The OECD has implemented a multi-country stated preference valuation project that covers ten chemicals-related health conditions (e.g. asthma, kidney disease, infertility, etc.) with more than 80 surveys with large samples in 22 countries. The OECD Surveys on Willingness-to-Pay to Avoid Negative Chemicals-Related Health Impacts (SWACHE) project aims to establish internationally comparable values for the willingness-to-pay (WTP) to avoid negative health effects due to exposure to chemicals. The values can be used to demonstrate and measure the economic benefits of minimising the morbidity impacts of chemical regulations, environmental policies and public policies in general. The latest valuation results of the project will be presented, along with key aspects of the joint methodology used and the plans to further expand this work. In addition, the OECD is collaborating with other intergovernmental organisations via the Inter-Organization Programme for the Sound Management of Chemicals (IOMC) to update the cost of inaction estimates for chemicals as part of the Global Framework on Chemicals. An update on this initiative, that can benefit from the results of the SWACHE project, will be provided.

Preventive health-care behavior: a serial multiple mediation analysis

Purpose Preventive health-care behavior (PHB) adoption as a primordial prevention to stay healthy and avoid lifestyle disease risk is a global trend. This paper aims to use the PHB model and stimulus-organism-response theory to empirically examine the role of individual and technological factors in influencing primordial PHB. Design/methodology/approach A sequential mixed-method was adopted to identify the primordial PHB adoption and propose a conceptual framework. The identified determinants and the hypothesized relationships were empirically tested using a convenience sample of 406 urban Indians. Partial least square structural equation modeling is used for data analysis. Findings The derived conceptual framework was empirically tested to assess the role of health literacy (HL), health value (HV) and digital health information seeking (DHIS) on primordial PHB. Findings confirmed the significant influence of DHIS on HL, HL on HV and PHB and HV on PHB. The direct effects of DHIS on PHB and HV were insignificant. HL solely mediated the indirect effect of DHIS on PHB, while the mediation of HV was insignificant. HL and HV fully mediated the relationship between DHIS and PHB. Research limitations/implications The impact of DHIS on PHB adoption and the serial multiple mediating roles of HL and HV are significant in understanding primordial PHB adoption for both academic theory and practice. However, the cross-sectional study on urban Indians needs further validation across geographies. Originality/value To the best of the authors’ knowledge, this pioneering study is among the first to propose and validate a comprehensive model of primordial PHB adoption.

Scale and rate heterogeneity in the EQ-5D-5L valuation

ObjectivesTo estimate values on a quality-adjusted life year (QALY) scale using individual preference evidence, choice analyses typically include ancillary parameters, such as scale factors and discount rates. These parameters potentially differ among respondents. In this study, we investigated how allowing heterogeneity in scale and rate affects the estimation of EQ-5D-5L values.MethodsUsing the first wave of the 2016 EQ-5D-5L valuation study (N = 1017), we estimated a conditional logit (CL) model and three mixed logit models: random scale, random rate, and bivariate. Prior to the exploratory study, we hypothesized that scale and rate are correlated and that allowing heterogeneity in both parameters decreases the number of insignificant incremental effects. We confirmed the exploratory findings by re-estimating these models using paired comparison responses from a second wave (N = 1229).ResultsScale and rate exhibited significant heterogeneity and were positively correlated. As hypothesized, allowing this heterogeneity improved the face validity of the EQ-5D-5L value set by reducing the number of insignificant incremental effects (from 6 to 2 p-values > 0.05; out of 20). Nevertheless, the CL and bivariate mixed logit estimates are highly correlated and concordant (Pearson correlation coefficient of 0.897, Spearman correlation coefficient of 0.888, Lin’s concordance coefficient of 0.763).ConclusionsAllowing this heterogeneity adds three parameters to the estimation (two variances and a correlation) and improves the face validity of the EQ-5D-5L values. This finding may influence experimental design and choice analysis in health valuation more generally.

User intention to adopt public bicycle sharing system: a priori acceptance approach

ABSTRACT Bicycle-sharing services have received worldwide attention as a sustainable form of transportation. This study explores a priori acceptance of public bicycle-sharing system (PBSS) in India, which is still in the early phases of adopting PBSS. The effects of psychological factors, such as perceived usefulness (PU), perceived ease of use (PEoU), perceived fun (PF), health value (HV), and environment values (EV), on intention to use PBSS are studied, utilizing an extended technology acceptance model. 747 samples were collected from online questionnaires in Dehradun, India. Results of Structural Equation Modelling revealed that intention to use PBSS is strongly predicted by PU and PF together, while PF mediates the influence of PEoU. Furthermore, EV and HV generate positive behavior intention to use PBSS through PU, PF, and PEoU. The study suggests promoting PBSS as a green and active transportation mode offering high PU and enjoyment, with theoretical and practical implications discussed.

Who should value children's health and how? An international Delphi study

Valuing child health necessitates normative methodological decisions on whose preferences should be elicited and who should be imagined as experiencing impaired health. Formal guidance is limited and expert consensus unclear. This study sought to establish the degree of consensus among expert stakeholders on normative issues of who to ask and who should be imagined when valuing child health (7–17 years) to inform UK health technology assessment. Sixty-two experts (n = 47 in Round 2) from 18 countries participated in a modified, two-round online Delphi survey (Round 1: May-June 2023; Round 2: September-October 2023). Participants were expert stakeholders in child health valuation, including academics (n = 38); industry/consultancy representatives (including the charity/not-for-profit sector; n = 13); and UK policy/government representatives (n = 11). The Delphi survey was modified between rounds and consisted of 9-point Likert, categorical, multiple-choice, and free-text questions on normative issues in valuing child health. Responses were analysed descriptively and thematically. An a priori criterion of ≥75% agreement was established for formal consensus, while areas approaching consensus (≥70% agreement) and without consensus were identified as a future research primer. Consensus was observed that older adolescents (aged 16–17 years) and adults (18+ years) should be asked to value child health states. There was consensus that the former should think about themselves when valuing the health states and the latter should imagine a child of some form (e.g., imagining themselves as a child or another hypothetical child). However, no consensus was evident on what form this should take. Several other methodological issues also reached consensus. These findings are largely consistent with recent views elicited qualitatively from members of the public and other stakeholders on normative issues in valuing child health. The results mean that, contrary to what has been done in previous child health valuation studies, efforts should be made to involve both older adolescents (16+ years) and adults in child health valuation.

Quality- and productivity-adjusted life years: From QALYs to PALYs and beyond

We develop a unified framework for the measurement and valuation of health and productivity. Within this framework, we characterize evaluation functions allowing for compromises between the classical quality-adjusted life years (QALYs) and its polar productivity-adjusted life years (PALYs). Our framework and characterization results provide a new normative basis for the economic evaluation of health care interventions, as well as occupational health and safety policies, aimed to impact both health and productivity of individuals.

Understanding Canadian stakeholders’ views on measuring and valuing health for children and adolescents: a qualitative study

ObjectiveValuing child health is critical to assessing the value of healthcare interventions for children. However, there remain important methodological and normative issues. This qualitative study aimed to understand the views of Canadian stakeholders on these issues.MethodsStakeholders from health technology assessment (HTA) agencies, pharmaceutical industry representatives, healthcare providers, and academic researchers/scholars were invited to attend an online interview. Semi-structured interviews were designed to focus on: (1) comparing the 3-level and 5-level versions of the EQ-5D-Y; (2) source of preferences for valuation (adults vs. children); (3) perspective of valuation tasks; and (4) methods for valuation (discrete choice experiment [DCE] and its variants versus time trade-off [TTO]). Participants were probed to consider HTA guidelines, cognitive capacity, and potential ethical concerns. All interviews were recorded and transcribed verbatim. Framework analysis with the incidence density method was used to analyze the data.ResultsFifteen interviews were conducted between May and September 2022. 66.7% (N = 10) of participants had experience with economic evaluations, and 86.7% (N = 13) were parents. Eleven participants preferred the EQ-5D-Y-5L. 12 participants suggested that adolescents should be directly involved in child health valuation from their own perspective. The participants were split on the ethical concerns. Eight participants did not think that there was ethical concern. 11 participants preferred DCE to TTO. Among the DCE variants, 6 participants preferred the DCE with duration to the DCE with death.ConclusionsMost Canadian stakeholders supported eliciting the preferences of adolescents directly from their own perspective for child health valuation. DCE was preferred if adolescents are directly involved.

Systematic methodological review of health state values in glaucoma cost-utility analyses.

Describing the characteristics and sources of health state utility values and reporting practice in the literature of cost-utility analyses facilitates an understanding of the level of the transparency, validity, and generalizability of cost-utility analyses. Improving the quality of reporting will support investigators in describing the incremental value of emerging glaucoma interventions. To describe the state of practice among published glaucoma cost-utility analysis studies, focusing on valuation of health and the quality of reporting. We searched several databases including Medline, CINHAL, Embase, Web of Science, Scopus, Biosis previews, the Health Economic Evaluations Database, and the NHS Economic Evaluation Database (NHS EED). We included full-text, English, published cost-utility analyses of glaucoma interventions with quality-adjusted life years (QALYs) as the primary outcome measure to calculate incremental cost-utility ratios. Excluded studies were non-English language, reviews, editorials, protocols, or other types of economic studies (cost-benefit, cost-minimization, cost-effectiveness). Study characteristics, operational definitions of glaucoma health states and health state utilities were extracted. The original source of the health utility was reviewed to determine the scale of measurement and the source of preference weighting. Items from the Systematic Review of Utilities for Cost-Effectiveness (SpRUCE checklist) were used to assess the reporting and quality of health utilities in glaucoma CUA. 43 CUAs were included, with 11 unique sources of health utilities. A wide range of health utilities for the same Hodapp-Parrish-Anderson glaucoma health states were reported; ocular hypertension (0.84-0.95), mild (0.68-0.94), moderate (0.57-0.92), advanced (0.58-0.88), severe/blind (0.46-0.76), and bilateral blindness (0.26-0.5). Most studies reported the basis for using health utilities (34, 79%) and any assumptions or adjustments applied to the health utilities (22, 51%). Few studies reported a framework for assessing the relevance of health utilities to a decision context (8, 19%). Even fewer (3, 7%) applied a systematic search strategy to identify health utilities and used a structured assessment of quality for inclusion. Overall, reporting has not improved over time. This review describes that few CUAs describe important rationale for using health state utility values. Including additional details on the search, appraisal, selection, and inclusion process of health utility values improves transparency, generalizability and supports the assessment of the validity of study conclusions. Future investigations should aim to use health utilities on the same scale of measurement across health states and consider the source and relevance to the decision context/purpose of conducting that cost-utility study.

Abstract WMP79: Mobility Impairment is Not Associated With Long-Term Valuation of Health by Survivors of Intracerebral Hemorrhage: A Mediation Analysis

Introduction: Clinical trial outcomes such as the modified Rankin score (mRS) are heavily influenced by mobility. We examined if mobility impairment and functional disability influenced long-term overall health evaluation by survivors of intracerebral and intraventricular hemorrhage (ICH/IVH). Methods: We pooled data from MISTIE-III and CLEAR-III trials. ICH/IVH survivors performed a protocolized direct valuation of their overall health using time trade-off utility (TTO-U) at 6 months post-ictus. TTO-U asks responders to consider trading years off their current disability-stricken state in exchange for perfect health. TTO-U index ranges from 0-1, with lower scores indicating greater years traded off and poorer valuation of overall health. TTO-U scores were dichotomized as good (>=0.7) and poor (<0.7). Associations between functional outcomes, European quality of life 5 dimensions (EQ-5D) and poor TTO-U at 6-months were assessed in multivariable logistic regression. A mediation analysis evaluated if mobility impairment and persistent poor mRS (mRS4-5) mediated associations between significant covariates and poor TTO-U at 6-months. Results: Of 773 survivors at 6-months, 442 (57%) patients with median (IQR) mRS of 3 (3-4) reported median (IQR) TTO-U of 1 (0.7-1); 332 patients had good and 110 had poor TTO-U. In multivariable logistic regression, moderate to severe anxiety/depression and problems with selfcare (dressing/washing) were independently associated with poor valuation of overall health, but mobility impairment and poor functional outcome were not. In mediation analyses, mobility impairment and poor mRS (4-5) at 6-months did not mediate the effect of persistent anxiety/depression (controlled direct effect (CDE), 1.79 [1.10-2.89]; natural indirect effect (NIE) of mobility, 0.93 [0.58-1.49], p=0.75; NIE of mRS, 1.00 [0.91-1.10], p=0.96) and selfcare deficits (CDE, 4.85 [2.13-11.05]; NIE of mobility, 0.72 [0.42-1.26]; NIE of mRS, 1.04 [0.78-1.39]) on long-term valuation of health state. Conclusions: Long-term valuation of overall health in survivors after severe ICH/IVH was influenced by persistent dependence in caring for self and mood dysfunction. Mobility impairment and mRS did not mediate these associations.

The RETRIEVE Checklist for Studies Reporting the Elicitation of Stated Preferences for Child Health-Related Quality of Life.

Recent systematic reviews show varying methods for eliciting, modelling, and reporting preference-based values for child health-related quality-of-life (HRQoL) outcomes, thus producing valuesets with different characteristics. Reporting in many of the reviewed studies was found to be incomplete and inconsistent, making them difficult to assess. Checklists can help to improve standards of reporting; however, existing checklists do not address methodological issues for valuing child HRQoL.Existing checklists also focus on reporting methods and processes used in developing HRQoL values, with less focus on reporting of the values' key characteristics and properties. We aimed to develop a checklist for studies generating values for child HRQoL, including for disease-specific states and value sets for generic child HRQoL instruments. A conceptual model provided a structure for grouping items into five modules. Potential items were sourced from an adult HRQoL checklist review, with additional items specific to children developed using recent reviews. Checklist items were reduced by eliminating duplication and overlap, then refined for relevance and clarity via an iterative process. Long and short checklist versions were produced for different user needs. The resulting long RETRIEVE contains 83 items, with modules for reporting methods (A-D) and characteristics of values (E), for researchers planning and reporting child health valuation studies. The short RETRIEVE contains 14 items for decision makers or researchers choosing value sets. Applying the RETRIEVE checklists to relevant studies suggests feasibility. RETRIEVE has the potential to improve completeness in the reporting of preference-based values for child HRQOL outcomes and to improve assessment of preference-based value sets.

Distributionally sensitive measurement and valuation of population health

We introduce a measure of population health that is sensitive to inequality in both age-specific health and lifespan and can be calculated from a health-extended period life table. By allowing for inequality aversion, the measure generalises health-adjusted life expectancy without requiring more data. A transformation of change in the (life-years) measure gives a distributionally sensitive monetary valuation of change in population health and disease burden. Application to Sub-Saharan Africa between 1990 and 2019 reveals that the change in population health is sensitive to allowing for lifespan inequality but is less sensitive to age-specific health inequality. Allowing for distributional sensitivity changes relative burdens of diseases, reduces convergence between the burdens of communicable and non-communicable diseases, and so could influence disease prioritisation. It increases the value of health improvements relative to GDP.

Do people with different sociodemographic backgrounds value their health differently? Evaluating the role of positional objectivity.

The fundamental disconnect between the actual and the perceived health of an individual raises considerable skepticism on the self-reported health data as it may be confounded by an individual's socio-economic status. In this light, the present study aims to assess if people with different sociodemographic backgrounds value their health differently. The health-state valuation using time-trade off was performed in a cross-sectional survey among a representative sample of 2,311 adults from India. Individuals were selected using a multistage stratified random sampling from five Indian states to elicit their present health-state, and to perform the health-state valuation exercise using computer assisted personal interviewing. A single block of standardized health-states was valued by multiple individuals, each belonging to different socio-demographic group. The difference in the valuation of health was assessed using bivariate analysis. The impact of different sociodemographic factors on the health-state valuation was evaluated using Tobit regression model. Differences in the valuation of health were observed among different groups of age, religion, family type, state of residence, substance abuse, presence of ailments at the time of valuation, and number of dependent members in the household. Even after controlling for the severity of the administered health states, factors having a significant association with the valuation of health are age, religion, state of residence, substance abuse, family type, number of dependent members in the household, and presence of chronic or both acute and chronic ailments. Younger individuals place a higher value to their health as compared to their older counterparts. As compared to a healthy individual, a person with ailments rates the same health-state as worse. Inequalities in self-reported ill-health cannot be attributed to positional objectivity; age, religion, state of residence, substance abuse, family type, dependents, and ailments impact individual health valuation.

Examining Antecedents of Factual Knowledge and Perceived Familiarity of COVID-19 Contact Tracing App: A Modified Cognitive Mediation Model

This study employs a modified cognitive mediation model to investigate the role of health valuation and fear in shaping media attention, factual knowledge, and perceived familiarity with COVID-19 contact tracing apps. Data were collected from a national survey of 906 Singaporeans, and structural equation modeling was used to analyze the results. Findings indicated that both fear of COVID-19 and health valuation were positively associated with newspapers, television, and social media attention, with health valuation demonstrating a stronger association with each media type. This suggests that health valuation, as an intrinsic motivation, is more critical in information-seeking behavior related to emerging health technologies. However, media attention on all platforms did not correlate with factual knowledge of COVID-19 contact tracing apps, whereas attention to social media was positively associated with perceived familiarity with these apps. This result highlights the potential influence of social media in shaping public perceptions, warranting further investigation into the quality and accuracy of the information disseminated. News elaboration was found to have a positive association with both factual knowledge and perceived familiarity with COVID-19 contact tracing apps. This underscores the need for effective communication strategies to promote accurate understanding of health technologies and emphasizes the role of individual motivations in shaping media consumption and information processing.

Quantifying the health impacts of alternative urban development scenarios using the HAUS tool

Abstract Local authorities face a capacity challenge to balance policy considerations when master-planning an area for redevelopment. Effects of redevelopment on residents’ health comprise one competing priority alongside financial viability, sustainability and employment provision. The challenge is not a lack of data, but a lack of accessible tools to help LAs synthesise and interpret complex information about health effects. We address this by creating a health-economic valuation model which allows the user to understand health trade-offs entailed in alternative scenarios and relative to other costs and benefits. The model applies evidence to quantify and monetise the potential impact on health outcomes related to characteristics of the urban environment. The model is driven by a set of 200+ environment-health impact pathways supported by systematic reviews of evidence relating to building design, natural environment, community infrastructure and transport. We estimate the societal value of changes to health using a database of economic values for 70+ physical and mental health outcomes. Values include costs of treatment, productivity loss and pain & suffering associated with ill health, and are disaggregated according to who bears the costs, e.g. NHS, police. Values are modelled for a synthetic population which can be tailored to local contexts, allowing for aggregation. We apply the model to a regeneration site in Bristol, UK, identifying health outcomes resulting from alternative land use scenarios for the site. Model outputs were used to inform the process of developing a Spatial Regeneration Framework and preferred land use scenarios within the regeneration site. Our research helped to widen out the number of health impacts considered by the design team, and to build a strong case for healthy policy options such as enhanced green space within the strategic framework, ensuring that health data can be built into negotiations with developers in the implementation phase. Key messages • Economic valuation of health impacts of urban environment leads to better public health decision-making. • The HAUS model allows better-informed trade-offs between health and urban investment to be made.

VOLY: The Monetary Value of a Life-Year at the End of Patients' Lives.

We explored the monetary value of the end-of-life (EoL) health gains, that is, the value of a life-year (VOLY) gained at the end of a patient's life in Croatia. We tested whether the nature of the illness under valuation (cancer and/or rare disease) is a factor in the valuation of EoL-VOLYs. The aim was for our results to contribute to the health and longevity valuation literature and more particularly to the debate on the appropriate cost-effectiveness threshold for EoL treatments as well as to provide input into the debate on the justifiability of a cancer and/or a rare disease premium when evaluating therapies. A contingent valuation was conducted in an online survey using a representative sample of the Croatian population (n = 1500) to calculate the willingness to pay for gains in the remaining life expectancy at the EoL, from the social-inclusive-individual perspective, using payment scales and an open-ended payment vehicle. Our approach mimics the actual decision-making problem of deciding whether to reimburse therapies targeting EoL conditions such as metastatic cancer whose main purpose is to extend life (and not add quality to life). Average EoL-VOLY across all scenarios was estimated at €67,000 (median €40,000). In scenarios that offered respondents 1 full year of life extension, EoL-VOLY was estimated at €33,000 (median €22,000). Our results show that the type of illness is irrelevant for EoL-VOLY evaluations. The pressure to reimburse expensive therapies targeting EoL conditions will continue to increase. Delivering "value for money" in healthcare, both in countries with relatively higher and lower budget restrictions, requires the valuation of different types of health gains, which should, in turn, affect our ability to evaluate their cost effectiveness.

Child health valuation protocol for a discrete choice experiment comparing paired comparison and kaizen tasks and estimating US EQ-5D-Y-3L values on an experience scale

IntroductionA decade ago, the first national valuation study of the EQ-5D-Y-3L (Y-3L) involved a discrete choice experiment (DCE) that asked 4155 US adult respondents to complete 40 paired comparisons, choosing...

When sterilizations lower immunizations: The Emergency experience in India (1975–77)

In the 1970s in India, an aggressive family planning program resulted in more than eight million sterilizations in only a few months. Under the assumption that this extremely unpopular sterilization campaign may have shaped demand for health services, we study the effect of this event on children’s immunization and hospital births. To account for possible non-randomness in coercion intensity, we use a difference-in-difference empirical strategy, which relies on the unexpected timing of the program and mother and village fixed effects. We show that an increase in district-wise sterilizations, compared to the previous period, led to a substantial decrease in the use of these services, especially vaccination. Further evidence supports a decline in trust rather than a change in health supply or valuation of children.

What types of health evidence persuade policy actors in a complex system?

The aim of this article is to explore the types of health evidence that diverse actors find most persuasive in a complex policy system. The impact of evidence depends on many factors, including how it is presented and translated to audiences. If diverse actors are to address complex health challenges collectively, it helps if they can draw on evidence that is accessible and meaningful to all. We explore how this can be done through a case study of promoting healthy urban development in the United Kingdom. Based on 132 in-depth interviews with critical actors from across the urban development system, we examined the types of evidence actors find most helpful. While there was some variation by sector, actors revealed a strong preference for narratives with a strong emotional impact, supported by credible evidence. Urban development decision makers are persuaded by both qualitative and quantitative evidence, although there was a slight preference among the public sector for quantitative data. All actors valued evidence on the impact of the urban environment on population health outcomes and the associated costs of ill health. There was, however, a preference among private sector actors for evidence showing economic valuations of health that demonstrate a commercial advantage. Our findings make an important contribution to the evidence-based policy literature by identifying the types of health evidence that appeal to diverse actors in the urban development system. These insights can be used to design evidence that meets the requirements of all actors in a complex system.

Willingness to Pay for Medicines used in the Management of Hypertension and Diabetes Mellitus in Plateau State, Nigeria.

Background: Due to poverty, in low- and middle-income countries the increase in cost leading to unwillingness to pay for life long treatment of most chronic diseases like hypertension and diabetes in Nigeria is always on the increase resulting to increase in morbidity and mortality. To fifind out the solution, the willingness to pay for essential medicines by hypertensive and diabetic patients in Jos and environs in 2019 was used as a tool. Method: A cross sectional descriptive study using the health valuation method with the 5 dimension 3 level version of European Quality of Life 5 Dimensions 3 Level Version EQ-5D (EQ-5D-3L) is a generic tool for Patient Reported Outcomes (PRO) measurement that can assess patients' quality of life, irrespective of the disease introduced in 1990 by the European quality of life (EuroQol) group questionnaire was adopted the fifive dimensions namely: Mobility, Self-care, Usual activities, Pain / discomfort, and Anxiety / depression while the 3 Levels include: No problems/ pain/ anxiety, Some problems/ pain/ anxiety, and Extreme problems/ pain/anxiety. Results: Out of the 360 respondents of which majority were females 192 (53.3%), respondents aged 55 years were in majority 303 (84.2%). Those with hypertension were higher 257 (71.40%) than those with diabetes and those with both diseases. Majority of the respondents earn between NGN61,000 to NGN140,000 23 (64.5%) while only 5 (1.4%) of them earn NGN181,000 and above. Conclusion: Most of the respondents (75.4%) where willing to pay between NGN3,000.00 and less for their treatment while only a few (1.2%) where willing to pay NGN15,000.00 and above. Over 70% of the respondents indicated no problems with mobility, self-care, carrying out usual activities, and anxiety/depression while 98.2% had no problems of taking care of themselves. There was signifificant relationship between gender and anxiety/depression (P-0.001). Married respondents reported problems with mobility more than others (P=0.0001). Those who earn between NGN61,000 and NGN100,000 signifificantly did not have any problems with mobility (P=0.0001) and self-care (P=0.031) respectively compared to other income categories.&nbsp

Preference heterogeneity in health valuation: a latent class analysis of the Peru EQ-5D-5L values

BackgroundPreference heterogeneity in health valuation has become a topic of greater discussion among health technology assessment agencies. To better understand heterogeneity within a national population, valuation studies may identify latent groups that place different absolute and relative importance (i.e., scale and taste parameters) on the attributes of health profiles.ObjectiveUsing discrete choice responses from a Peruvian valuation study, we estimated EQ-5D-5L values on a quality-adjusted life-year (QALY) scale accounting for latent heterogeneity in scale and taste, as well as controlling heteroskedasticity at task level variation.MethodWe conducted a series of latent class analyses, each including the 20 main effects of the EQ-5D-5L and a power function that relaxes the constant proportionality assumption (i.e., discounting) between value and lifespan. Taste class membership was conditional on respondent-specific characteristics and their experience with the composite time trade-off (cTTO) tasks. Scale class membership was conditional on behavioral characteristics such as survey duration and self-stated difficulty level in understanding tasks. Each analysis allowed the scale factor to vary by task type and completion time (i.e., heteroskedasticity).ResultsThe results indicated three taste classes: a quality-of-life oriented class (33.35%) that placed the highest value on levels of severity, a length-of-life oriented class (26.72%) that placed the highest value on lifespan, and a middle class (39.71%) with health attribute effects lower than the quality class and lifespan effect lower than the length-of-life oriented class. The EQ-5D-5L values ranged from − 2.11 to 0.86 (quality-of-life oriented class), from − 0.38 to 1.02 (middle class), and from 0.36 to 1.01 (length-of-life oriented class). The likelihood of being a member of the quality-of-life class was highly dependent on whether the respondent completed the cTTO tasks (p-value < 0.001), which indicated that the cTTO tasks might cause the Peru respondents to inflate the burden of health problems on a QALY scale compared to those who did not complete the cTTO tasks. The results also showed two scale classes as well as heteroskedasticity within each scale class.ConclusionAccounting for taste and scale classes simultaneously improveds understanding of preference heterogeneity in health valuation. Future studies may confirm the differences in taste between classes in terms of the effect of quality of life and lifespan attributes. Furthermore, confirmatory evidence is needed on how behavioral variables captured within a study protocol may enhance analyses of preference heterogeneity.