Time Trade-off Method Research Articles

Elicitation and modelling of imprecise utility of health states

Utilities of health states are often estimated to support public decisions in health care. People’s preferences may be imprecise, for lack of actual trade-off experience. We show how to elicit the utilities accounting for imprecision (using fuzzy sets), discover the main drivers of imprecision, and compare several approaches to modelling health state utility data in the fuzzy setting. We extended the time trade-off (TTO) questionnaire, to elicit utilities of states defined in the EQ-5D-3L descriptive system (health described by five dimensions) in184 respondents. Our study demonstrates that respondents are capable of assessing their own imprecision and rigorous mathematical modelling is possible. The imprecision is larger than as inferred from the standard TTO method and is larger than estimation error, even in our smallish sample. Non-trading in TTO often results from imprecision, rather than lexicographic preferences for longevity over quality. People are especially imprecise in assessing the impact of usual activities (one of the dimensions) on utility; also, the internal inconsistency of a health state increases the imprecision. Fuzzy least squares method seems best suited to assign disutilities to individual dimensions, while separately modelling the location of utility and amount of imprecision seems best to produce value sets. If crisp parameters are estimated, accounting for imprecision changes the results little.

Health state utilities for infertility and subfertility

BackgroundHealth state utility values allow for comparison of treatments across different diseases. Utility values for fertility-impaired health states are currently unavailable. Such values are necessary in order to determine the relative costs-effectiveness of fertility treatments.MethodsThis study aimed to determine utility weights for infertile and subfertile health states. In addition, it explored the Dutch general population’s opinions regarding the inclusion of infertility treatments in the Dutch health insurers’ basic benefit package. An online questionnaire was designed to determine the health-related quality of life values of six fertility-impaired health states. The study population consisted of a representative sample of the Dutch adult population. Respondents were asked to evaluate the health states through direct health valuation methods, i.e. the Visual Analogue Scale (VAS) and the Time Trade-Off (TTO) method. In addition, respondents were asked about their opinions regarding reimbursement of fertility-related treatments.ResultsThe respondents’ (n = 767) VAS scores ranged from 0.640 to 0.796. TTO utility values ranged from 0.792 to 0.868. Primary infertility and subfertility was valued lower than secondary infertility and subfertility. In total, 92% of the respondents stated that fertility treatments should be fully or partially reimbursed by the health insurance basic benefit package.ConclusionsHaving fertility problems results in substantial disutilities according to the viewpoint of the Dutch general population. The results make it possible to compare the value for money of infertility treatment to that of treatments in other disease areas. There is strong support among the general population for reimbursing fertility treatments through the Dutch basic benefit package.

Valuation of Quality Weights for EuroQol 5-Dimensional Health States With the Time Trade-Off Method in the Capital of Iran

BackgroundThe EuroQol 5-dimension (EQ-5D) is a standard instrument that is widely used for measuring health-related quality of life and quality-adjusted life years in economic evaluation of healthcare interventions. ObjectiveTo estimate a preference valuation set for EQ-5D 3-level (3L) health states from the perspective of the general population in the capital of Iran. MethodsEight hundred seventy adults aged ≥18 years were interviewed in Tehran (Iran's capital) from July to November 2013. The participants were selected by a stratified random sampling method and were interviewed face-to-face at their usual residence. Forty-two health states were selected and valued from the 243 states derived from the EQ-5D-3L instrument. Each respondent valued 11 health states using the time trade-off method. Generalized least squares regression with random effect was used to predict values for health states. ResultsThe analysis was performed for 846 respondents. The final model yielded the best fit for the time trade-off value at the individual level with an overall R2 of 0.45 and a mean absolute error of 0.214. The mean values for the 42 health states ranged from 0.934 for state 11121 to -0.142 for state 33333. ConclusionsThis study provided for the first time a value set for calculating quality-adjusted life years from the EQ-5D instrument in Iran. The Iranian EQ-5D-3L value set slightly differs from the value sets of the UK and the United States.

Does the Time Trade-Off Method Reflect Health-Related Quality of Life? A Mixed-Methods Analysis of Preference Measures 10 Years After Aneurysmal Subarachnoid Hemorrhage

To investigate if the time trade-off (TTO) method reflects health-related quality of life (HRQoL) 10 years after an aneurysmal subarachnoid hemorrhage (aSAH). A cross-sectional study with a mixed-methods approach was used to follow up 208 patients treated for aSAH. Data were collected with intramethod mixing; the quantitative data consisted of the EQ-5D-3L instrument and a TTO question, and the qualitative data comprised motivations to the TTO answer. The quantitative data were analyzed statistically and comparisons were made between participants willing to trade off years and those not willing to trade off years. The qualitative data were merged in a matrix and analyzed with manifest content analysis. Participants willing to trade off years scored significantly lower HRQoL, and the correlation between EQ-5Dindex and EQ VAS to TTO values were rs= 0.369 (P < 0.001) and rs= 0.345 (P < 0.001), respectively. In the content analysis, 4 categories emerged: perceived full health or satisfactory life; adaptability and managing strategies; the importance of hope and meaning in life; and unacceptable changes do not make life worth living. The results showed that several reasons other than health status were evident when expressing the willingness to trade off or not trade off life-years. Individuals willing to trade off years showed significantly poorer HRQoL; however the TTO method did not seem to fully reflect HRQoL. Most participants did not want to trade off years, despite their living with severe disability, making it difficult to fully rely on the TTO method in evaluation of medical outcome.

Estimating utilities/disutilities for high-risk metastatic hormone-sensitive prostate cancer (mHSPC) and treatment-related adverse events

PurposeTo capture UK societal health utility values for high-risk metastatic hormone-sensitive prostate cancer (mHSPC) and the disutility associated with treatment-related adverse events (AEs) to inform future cost–utility analyses.MethodsA literature review, and patient and clinical expert interviews informed the development of health states characterising mHSPC symptoms and the impact of treatment-related AEs on health-related quality of life (HRQL). Three base health states were developed describing a typical patient with high-risk mHSPC: receiving androgen deprivation therapy (ADT) [Base State 1]; receiving docetaxel plus ADT [Base State 2]; completed docetaxel and still receiving ADT whose disease has not yet progressed [Base State 3]. Six additional health states described treatment-related AEs. The health states were validated with experts and piloted with general public participants. Health state utilities were obtained using the time trade-off (TTO) method with 200 members of the UK general population. A generalised estimating equation (GEE) model was used to estimate disutility weights.ResultsMean TTO scores for Base State 1 to 3 were 0.71 (SD = 0.26), 0.64 (SD = 0.27), and 0.68 (SD = 0.26), respectively, indicating that receiving docetaxel plus ADT was most impactful on HRQL. The GEE model indicated when compared to Base State 2 that the nausea and vomiting AE had the most impact on HRQL (− 0.21), while alopecia was least burdensome (− 0.04).ConclusionsThe study highlights the differences in utility between base health states and the significant impact of treatment-related AEs on the HRQL of patients with mHSPC. These findings underline the importance of accounting for impaired HRQL when assessing treatments for mHSPC.

Utility after robot-assisted radical prostatectomy compared to conventional approaches for localized prostate cancer [socioeconomic perspective study

This study presented the utility across approaches (robotic-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) or open radical prostatectomy (ORP)), across disease states after surgery, and also across functional outcomes for localized prostate cancers. The utility was measured using the time trade-off method. This survey was based on a scenario that describes the state of health in detail and considers surgical methods, short-term adverse effects following RP, disease-specific conditions, and additional treatments 1 year following RP. This study analyzed 393 men; the utility values are as follows: first, health status postoperatively showed that the utility value decreased in patients who underwent ORP versus those who underwent LRP. The utility value for ORP and LRP versus RARP was reduced by ~0.028 (10 days per year) and 0.008 (3 days per year), respectively. Second, the utility value based on adverse effects after RP indicated that erectile dysfunction caused a greater reduction in efficacy than urinary incontinence. Regarding erectile dysfunction and urinary incontinence, the efficacy was reduced to ~0.137 (50 days per year) and 0.111 (41 days per year), respectively, as compared to a health state without adverse effects based on no evidence of disease status. In conclusion, the disutility was much greater due to the side effects than the disutility due to the difference in the surgical method. In particular, the disutility of erectile dysfunction was bigger than that of the urinary incontinence.

The Worth of a Quality-Adjusted Life-Year in Patients with Diabetes: An Investigation Study using a Willingness-to-Pay Method.

BackgroundA limited number of studies have specifically examined the value of quality-adjusted life-years (QALYs) from the patient’s perspective.ObjectiveThe goal of this study was to investigate the worth of QALYs from the perspectives of patients with diabetes using health and willingness-to-pay (WTP) measures.MethodsA hypothetical treatment characterized by a permanent cure was presented to 149 patients with diabetes in Tehran, Iran, to elicit the monetary value that they attach to QALYs. The QALY gains of the participants were determined using the EuroQol-5 Dimensions, 3 Levels instrument, the visual analogue scale, and the time trade-off method. A mixed closed-ended WTP model supported by an open-ended question was used to ascertain the monetary value of a QALY gained. Finally, we used each respondent’s ratio of WTP to QALY gained and the mean of the ratios to estimate the worth of a QALY to all respondents.ResultsIn total, 96% of respondents were willing to pay out of pocket for the restoration of full health, whereas 4% exhibited a zero WTP because of an inability to pay. The mean WTP per QALY varied depending on the health measure and discount rate used, ranging from $US1191 to $US5043 in sensitivity analysis, which is equal to 0.23–0.95 of Iran’s gross domestic product (GDP) per capita in 2015.ConclusionApplying the upper limit of the World Health Organization’s (WHO) cost-effectiveness threshold (i.e., three times the local GDP per capita) in resource allocation decisions requires caution and investigation, particularly in low- and middle-income countries with limited healthcare resources. To generalize our findings, especially for application to decision making, additional surveys involving more representative samples from different settings are recommended.Electronic supplementary materialThe online version of this article (10.1007/s41669-018-0111-2) contains supplementary material, which is available to authorized users.

Valuation of Health States Considered to Be Worse Than Death—An Analysis of Composite Time Trade-Off Data From 5 EQ-5D-5L Valuation Studies

ObjectivesTo evaluate the discriminative ability of negative values measured in 5-level EuroQol 5-dimensional questionnaire (EQ-5D-5L) value set studies. MethodsThis is a secondary analysis of EQ-5D-5L value set studies from Singapore, the Netherlands, China, Thailand, and Canada in which health state values were elicited from a general population sample using a composite time trade-off (TTO) method. Mean values were calculated for health states with same severity. The association between the mean values and severity was evaluated using Pearson correlation (r). A linear mixed model using severity as the fixed effect was fitted for values. The analyses were performed separately for positive values (from a conventional TTO for health states considered “better than death”) and negative values (from a lead time TTO for health states considered “worse than death”). ResultsIn Singapore (N = 1000; negative values 32.6%), the mean decreased with severity from 0.89 to 0.21 for positive values and increased with severity from −0.98 to −0.89 for negative values. The correlation between values and severity was much lower for negative values (r = −0.016) than for positive values (r = −0.614). The coefficient of severity in the linear mixed model for negative values was much smaller (coefficient = −0.009; pseudo-R2 < 0.001) compared with the model for positive values (coefficient = −0.041; pseudo-R2 = 0.337). Results using data sets from the other countries were similar. ConclusionsNegative values are not associated with severity of health states in EQ-5D-5L valuation studies, suggesting poor discriminative ability of the lead time TTO method in valuing health states considered worse than death.

Estimating the utility value of hypoglycaemia according to severity and frequency using the visual analogue scale (VAS) and time trade-off (TTO) survey.

The primary objective of this study was to estimate the health utility values for hypoglycaemia events according to their severity and frequency. The secondary objective was to compare the health utilities between those with Type 2 Diabetes Mellitus and the general population. The health utilities of hypoglycaemia event were measured using Visual Analogue Scale (VAS) and Time Trade-Off (TTO) methods among conveniently sampled consenting adults (>18years and literate in either English or Malay language), which were then divided into two groups: those in the general population (GP) and those with Type 2 Diabetes Mellitus (T2DM). Each respondent was required to value 13 different health states, including frequencies of daytime hypoglycaemia and nocturnal hypoglycaemia, each depending on its severity (non-severe or severe). 256 respondents from the GP and 99 respondents with T2DM completed the survey. The T2DM group gave higher VAS-values compared to the GP group. The highest mean VAS-utility value for non-severe nocturnal hypoglycaemia occurring once monthly was 0.543 (SD 0.161), and for severe daytime hypoglycaemia occurring once quarterly was 0.293 (SD 0.162) which was the lowest utility value compared to other health states. However, non-severe nocturnal hypoglycaemia occurring once quarterly was 0.537 (SD 0.284) and has the highest TTO-utility value. Severe nocturnal hypoglycaemia occurring once quarterly has the lowest utility value which was -0.104 (SD 0.380). Daytime hypoglycaemia has lower utility value compared to nocturnal hypoglycaemia. Severe hypoglycaemia has a greater disutility compared with the non-severe hypoglycaemia in both studied groups. The findings show that as a health utility, hypoglycaemia has a substantial impact on utility with severe hypoglycaemia having a greater negative impact compared to non-severe events across the board. This highlights the importance of preventing development of severe hypoglycaemia in patients with Type 2 Diabetes Mellitus at any time of the day.

Scoring the Child Health Utility 9D instrument: estimation of a Chinese child and adolescent-specific tariff.

To derive children and adolescents' preferences for health states defined by the Chinese version of Child Health Utility 9D (CHU9D-CHN) instrument in China that can be used to estimate quality-adjusted life years (QALYs) for economic evaluation. A profile case best-worst scaling (BWS) and a time trade-off (TTO) method were combined to derive a Chinese-specific tariff for the CHU9D-CHN. The BWS survey recruited students from primary and high schools using a multi-stage random sampling method and was administered in a classroom setting, whilst the TTO survey adopted an interviewer-administrated conventional TTO task and was administered to a convenience sample of undergraduate students. A latent class modelling framework was adopted for analysing the BWS data. Two independent surveys were conducted in Nanjing, China, including a valid sample of 902 students (mean age 13years) from the BWS survey and a valid sample of 38 students (mean age 18years) from the TTO survey. The poolability of the best and the worst responses was rejected and the optimal result based on the best responses only. The optimal model suggests the existence of two latent classes. The BWS estimates were further re-anchored onto the QALY scale using the TTO generated health state values via a mapping approach. This study provides further insights into the use of the BWS method to generate health state values with young people and highlights the potential different decision rules that young people may employ for determining best vs. worst choices in this context.

Health-related quality of life in patients with uveitis

Background/aimsTo measure health-related quality of life (HRQOL) in patients with uveitis using time trade-off (TTO) and standard gamble (SG) methods of direct utility analysis.MethodsConsecutive patients attending a tertiary referral uveitis...

What utility scores do mental health service users, healthcare professionals and members of the general public attribute to different health states? A co-produced mixed methods online survey.

BackgroundUtility scores are integral to health economics decision-making. Typically, utility scores have not been scored or developed with mental health service users. The aims of this study were to i) collaborate with service users to develop descriptions of five mental health states (psychosis, depression, eating disorder, medication side effects and self-harm); ii) explore feasibility and acceptability of using scenario-based health states in an e-survey; iii) evaluate which utility measures (standard gamble (SG), time trade off (TTO) and rating scale (RS)) are preferred; and iv) determine how different participant groups discriminate between the health scenarios and rank them.Design and methodsThis was a co-produced mixed methods cross-sectional online survey. Utility scores were generated using the SG, TTO and RS methods; difficulty of the completing each method, markers of acceptability and participants’ preference were also assessed.ResultsA total of 119 participants (58%) fully completed the survey. For any given health state, SG consistently generated higher utility scores compared to RS and for some health states higher also than TTO (i.e. SG produces inflated utility scores relative to RS and TTO). Results suggest that different utility measures produce different evaluations of described health states. The TTO was preferred by all participant groups over the SG. The three participant groups scored four (of five) health scenarios comparably. Psychosis scored as the worst health state to live with while medication side-effects were viewed more positively than other scenarios (depression, eating disorders, self-harm) by all participant groups. However, there was a difference in how the depression scenario was scored, with service users giving depression a lower utility score compared to other groups.ConclusionMental health state scenarios used to generate utility scores can be co-produced and are well received by a broad range of participants. Utility valuations using SG, TTO and RS were feasible for use with service users, carers, healthcare professionals and members of the general public. Future studies of utility scores in psychiatry should aim to include mental health service users as both co-investigators and respondents.

Life After Surgery: Surgeon Assessments of Quality of Life Among Patients With Familial Adenomatous Polyposis.

Without prophylactic surgery, patients with familial adenomatous polyposis are at high risk for colorectal cancer development. Various surgical options for prophylaxis are available. Patient decision-making for preventative treatments is often influenced by the preferences of healthcare providers. We determined surgeon preferences for the surgical options available to patients with familial adenomatous polyposis. We obtained preference estimates for postoperative health states from colorectal surgeons who had treated ≥10 patients with familial adenomatous polyposis. Assessments were made at an annual meeting of the American Society of Colon and Rectal Surgeons. Utilities were measured through the time trade-off method. We determined utilities for 3 procedures used for prophylaxis, including total proctocolectomy with permanent ileostomy, colectomy with ileorectal anastomosis, and total proctocolectomy with IPAA. We also assessed utilities for 2 short-term health states: 90 days with a temporary ileostomy and 2 years with a poorly functioning ileoanal pouch. Twenty-seven surgeons who had cared for >1700 patients with familial adenomatous polyposis participated in this study. The highest utility scores were provided for colectomy with ileorectal anastomosis (0.98). Lower utility scores were provided for total proctocolectomy with permanent ileostomy (0.87) and IPAA (0.89). The number of patients with familial adenomatous polyposis who were treated by participating surgeons did not influence these estimates; however, more-experienced surgeons gave lower utility scores for a poorly functioning ileoanal pouch than less-experienced surgeons (0.15, 0.50, and 0.25 for high-, medium-, and low-volume surgeons; p = 0.02). This study was limited by the sample size. For patients with familial adenomatous polyposis and relative rectal sparing, surgeon preferences are greatest for colectomy with ileorectal anastomosis. Utility estimates provided by this study are important for understanding surgical decision-making and suggest a role for ileorectal anastomosis in appropriately selected patients. See Video Abstract at http://links.lww.com/DCR/A656.

A health state utility valuation study to assess the impact of treatment mode of administration in Gaucher disease

BackgroundThis study aimed to obtain UK societal-based utility values for health states related to treatment mode of administration using Gaucher disease as the background condition.MethodsA review of relevant literature and expert clinical input informed the development of five health states characterising the impact of Gaucher disease and its management on patients’ lives. A base-state characterising the “controlled disease” was developed as well as four subsequent health states which varied in description of the method (intravenous versus oral) and frequency of treatment administration. Health state utilities were obtained using the time trade-off (TTO) method via face-to-face interviews with 100 members from the UK general population. Before the valuation exercise, participants provided informed consent, completed a demographic form and the EQ-5D, and ranked the health states from best to worst on a 0–100 visual analogue scale (VAS).ResultsMean age of the participants (n = 100) was 35 years and 66% were female. Participants reported high EQ-5D VAS (86.1) and index scores (0.95) indicating very good health status. The “controlled disease” state had the highest mean TTO-derived utility value (0.89). There was only a marginal reduction in utility for the generic state for “Oral treatment” (0.85), while the reduction was more pronounced for the generic state for “Intravenous treatment” (0.73).ConclusionsThe findings suggest that the avoidance of the need for intravenous treatment administration is associated with a notable positive increase in health-related quality of life. Patient benefit arising from less invasive treatment could be an important consideration when undertaking economic evaluation of future therapies for Gaucher disease.

PP2 - Are Time Trade-Off Values of Worse-Than-Death Health States Valid?

To evaluate the validity of worse-than-death (WTD) values relative to better-than-death (BTD) values in 5-level EQ-5D value set studies from Singapore and the Netherlands. Health states were valued using the composite time trade-off (cTTO) method. Mean values were calculated for the severity distance from the full health (i.e., the sum of severity levels of given health-state minus 5) to examine correlation between utility value and severity. A linear mixed model (LMM) using 20 descriptor variables for severity levels in the five dimensions was fitted for utility values to examine the effect on health dimensions on utility value. The analyses were performed separately for BTD and WTD values. In Singapore (N=1000; proportion of WTD values: 32.6%), the mean of BTD values decreased from 0.89 to 0.21, whereas the mean of WTD values increased from -0.98 to -0.89 with increase in severity distance. Coefficients of the LMM based on BTD values ranged from -0.04 to -0.19 and were monotonic within each dimension with the exception between levels 4 and 5 for mobility and usual activities (Pseudo-R2 = 0.389). In contrast, 7 of the 20 coefficients (range: 0.027 to -0.034) of the model based on WTD values were positive; coefficients for only self-care and pain/discomfort were completely monotonic (Pseudo-R2 = 0.002). Results using the dataset from the Netherlands were similar to those from Singapore. WTD values are poorly associated with severity of health states, suggesting sub-optimal validity of the cTTO method for valuation of WTD EQ-5D health states.

PRM41 - Development of an Online Time Trade off Methods for Health State Valuation

Face to face time trade off (TTO) applications are expensive and time consuming. Therefore, it is important to explore an alternative robust online application for this classical valuation method. This study assessed the feasibility of using an online TTO method to elicit preferences for health states defined by the EQ-5D-5L classification system. An online panel (n=400) between 18 to 73 years of age was recruited for this study with the sample demographically similar to the Australian general population. The TTO procedure was developed following the TTO user manual from the University of York. Eighty six EQ-5D-5L health states were directly valued. Each respondent was given a randomly selected 10 health states to value as compared with full health (‘11111’). Basic demographics, co-morbidities and visual analogue scale data were also collected. The direct valuation of 86 health states from this online study were compared with the modelled values based on the Australian EQ-5D-5L algorithm based on discrete choice experiment (DCE). The degree of agreement between the two measures were determined using the Pearson and intra class correlation. There were 4,280 observations. Direct utility measures recorded as 0.5 (n=1,106) were excluded as it improves the agreement. Mean utility difference between this study and those calculated based on DCE approach was -0.03 (SD=0.24). Pearson correlation and ICC were 0.84 and 0.75 respectively. Further analysis need to be conducted to assess the reliability of excluded data. There are substantial similarities between the recorded direct valuation based on this online task and the derived values from the online DCE task used to develop the Australian EQ5D-5L algorithm. Further improvements to the online methods, such as including a confirmatory question for responses of 0.5 are suggested for further consideration.

Biomass water content effect on soil moisture assessment via proximal gamma-ray spectroscopy

Proximal gamma-ray spectroscopy supported by adequate calibration and correction for growing biomass is an effective field scale technique for a continuous monitoring of top soil water content dynamics to be potentially employed as a decision support tool for automatic irrigation scheduling. This study demonstrates that this approach has the potential to be one of the best space–time trade-off methods, representing a joining link between punctual and satellite fields of view. The inverse proportionality between soil moisture and gamma signal is theoretically derived taking into account a non-constant correction due to the presence of growing vegetation beneath the detector position. The gamma signal attenuation due to biomass is modelled with a Monte Carlo-based approach in terms of an equivalent water layer which thickness varies in time as the crop evolves during its life-cycle. The reliability and effectiveness of this approach is proved through a 7 months continuous acquisition of terrestrial gamma radiation in a 0.4 ha tomato (Solanum lycopersicum) test field. We demonstrate that a permanent gamma station installed at an agricultural field can reliably probe the water content of the top soil only if systematic effects due to the biomass shielding are properly accounted for. Biomass corrected experimental values of soil water content inferred from radiometric measurements are compared with gravimetric data acquired under different soil moisture levels, resulting in an average percentage relative discrepancy of about 3% in bare soil condition and of 4% during the vegetated period. The temporal evolution of corrected soil water content values exhibits a dynamic range coherent with the soil hydraulic properties in terms of wilting point, field capacity and saturation.

Health State Utilities in Edentulous Patients: A Time Trade-off Approach.

Health is generally regarded as a very high good, and oral health may substantially affect the quality of life of patients. Oral health-related quality of life has usually been investigated by means of disease-specific descriptive instruments, such as the Oral Health Impact Profile and the General Oral Health Assessment Index. These instruments, however, do not enable a comparison of oral health-related quality of life with other medical diseases. Economic methods, such as the time trade-off technique, enable a comparison of the impact of oral health with other medical diseases and thus provide a means to build a bridge in quality-of-life assessments between medicine and dentistry. We included in our study a total of 58 patients who received a complete denture in our clinic in the last 10 y (between January 2001 and May 2012) and who were ≥65 y old. Patient preferences for the edentulous and poorest imaginable oral health state were assessed via the time trade-off method. Edentulous patients rated their current oral health state as 0.73 (SD, 0.25) and the poorest oral health state as 0.43 (SD, 0.33) on a scale between 0 (death) and 1 (best possible health state). These results are comparable to patient preferences for other serious diseases, such as breast cancer (0.75), asymptomatic HIV infection (0.69), depression (0.44), and osteoarthritis of the hip (0.44). In conclusion, our results suggest that oral health may substantially affect quality of life no less than other medical diseases. Health is generally considered the highest good of humankind. In the present article, we show that oral health substantially affects quality of life. In particular, we show that loss of teeth (i.e., being edentulous) reduces quality of life no less than other systemic diseases. Treatment modalities for the edentulous patient may therefore substantially improve the patient's well-being and should be a research priority.

Health State Utilities Associated with Attributes of Weekly Injection Devices and Subdermal Implant for Treatment of Type 2 Diabetes

Cost-utility analyses include health utilities to compare medical treatments. Health utilities, ranging from 0 to 1, represent the strength of a patient’s preference for a drug profile or health-related outcome. Recently glucagon-like peptide-1 (GLP-1) receptor agonists have been used for management of glycemic control in type 2 diabetes (T2DM). Many GLP-1 drugs have similar modes of administration. In contrast, ITCA 650 is an investigational product which is an implantable device that, following subdermal placement, provides continuous delivery of exenatide for 3 or 6 months. The study’s purpose was to estimate health utilities associated with treatment processes of GLP-1s for use in economic models. During a UK-based pilot study, 19 general population (general population) participants completed time trade-off (TTO) interviews to value health states (often called vignettes or scenarios) which were based on literature review, instructions for use, and clinician interviews. A follow-up pilot study was conducted in both general population and T2DM participants to value modified health states. Participants were recruited to ensure equal distribution across gender and education levels. A total of 20 general population and 18 T2DM patients completed face-to-face interviews (general population mean age= 50.7; T2DM mean age = 56.2). Mean utilities (SD) for ITCA-650 were 0.93 (0.06) for T2DM patients and 0.91 (0.11) for the general population. Mean utility scores for injection health states ranged from 0.83-0.92 for T2DM and 0.82-0.91 for general population. Results are higher than others found in the literature for diabetes treatment processes (range: 0.85 to 0.88). A main study with 200 participants will be conducted in early 2018. Results may be useful in cost-utility models comparing the value of treatment processes for patients with T2DM. Findings suggest the TTO method may be used to quantify preferences among different treatment processes. Disclosure A.M. Rentz: Other Relationship; Self; Intarcia Therapeutics, Inc., Servier. K. Cutts: None. K. Washington: None. M. Beillat: None. K. Yu-Isenberg: Employee; Self; Intarcia Therapeutics, Inc..

Time Trade-Off Value Set for EQ-5D-3L Based on a Nationally Representative Chinese Population Survey

ObjectivesTo obtain a nationally representative Chinese three-level EuroQol five-dimensional questionnaire value set based on the time trade-off (TTO) method. MethodsA multistage, stratified, clustered random nationally representative Chinese sample was used. The study design followed an adapted UK Measurement and Valuation of Health protocol. Each respondent valued 11 random states plus state 33333 and “unconscious” using the TTO method in face-to-face interviews. Three types of models were explored: ordinary least squares, general least squares, and weighted least squares models. ResultsIn total, 5939 inhabitants aged 15 years and older were interviewed. Of these, 5503 satisfactorily interviewed participants were included in constructing models. An ordinary least squares model including 10 dummies without constant and N3 had a mean absolute error of 0.083 and a correlation coefficient of 0.899 between the predicted and mean values. Goodness-of-fit indices of two models based on split subsample were similar. ConclusionsTTO values were higher in our study compared with those in a study carried out in urban areas, which is mirrored by the higher values in rural areas. Several other aspects, in addition to the valuation procedure, might have influenced the results, such as factors beyond demographic factors such as view on life and death and believing in an afterlife, which need further investigation. Future studies using the three-level EuroQol five-dimensional questionnaire should consider using this value set based on a nationally representative sample of the Chinese population.