Journals
Journal:
HACIENDA PUBLICA ESPAÑOLA
ISSN:
0210-1173
Year:
2022
Vol.:
242
pp.
111 - 127
The quality-adjusted life year (QALY) approach as a paradigmatic measure of health outcomes is widely used in the economic evaluation of health policies and is even trying to be emulated in other public policy areas. The objective of this paper is to structure the arguments underlying the use of QALYs in cost-effectiveness analyses, which condition its applicability. To this effect, the paper intervenes in the unreasonable use of the approach in terms of its limitations when prioritizing health services. In short, the authors are generally in favor of the instrument but do not have blanket enthusiasm in support of it. © 2022, Instituto de Estudios Fiscales
Authors:
Attema, A. E. (Autor de correspondencia); Brouwer, W. B. F.; Pinto, José Luis
Journal:
VALUE IN HEALTH
ISSN:
1098-3015
Year:
2022
Vol.:
25
N°:
9
pp.
1559 - 1565
Objectives: People often give different weights to quality-adjusted life-years (QALYs) gained by different socioeconomic groups. It is well known that QALY gains of younger patients generally get more weight than the same QALY gains accruing to older patients. This study aims to separate these age-related preferences into "pure age weighting" and age weighting caused by full health not perceived as being the same for the old as for the young.Methods: We apply a person trade-off method in a large sample representative (N = 500) of the Dutch general adult population to estimate age weighting factors. We describe health as a percentage of what is considered full health for a given age, for which we obtain a proxy in a separate task.Results: A high amount of age weighting is observed, with QALYs to 20-year-old patients receiving approximately 1.5 times as much weight as QALYs to 80-year-old patients. At the same time, we see that individuals do not perceive full health to be the same for young and older people. In fact, the age weighting disappears once we control for these differences in full health perceptions.Conclusions: Respondents had strong preferences for the young relative to the old, but these preferences were related to full health perceptions, that is, more weight being assigned to younger because full health is at a higher absolute level for them than for the old.
Authors:
Sánchez-Martínez, F.; Martínez-Pérez, J.; Abellán-Perpiñán, J. M.; et al.
Journal:
JOURNAL OF RISK AND UNCERTAINTY
ISSN:
0895-5646
Year:
2021
Vol.:
63
N°:
2
pp.
203 - 228
This study estimates the value of statistical life (VSL) on a road traffic accident using the Contingent Valuation/Standard Gamble chained approach. A large representative sample (n = 2020) is used to calculate a VSL for use in the evaluation of road safety programmes in Spain. The paper also makes some methodological contributions, by providing new evidence about the consistency of the chained method. Our main results are: (1) A range from 1.3 million euro to 1.7 million euro is obtained for the VSL in Spain in the context of road accidents. This range is in line with the values used in the same context in other European countries, although it is lower than those obtained in different contexts and with other methods. (2) The method performs much better in terms of scope sensitivity than the traditional contingent valuation method, which asks subjects about their willingness to pay for very small reductions in the risk of death. (3) We introduce a new 'indirect' chaining approach which reduces (but does not remove) the disparity between direct and indirect chaining approaches. More extreme VSL estimates are still obtained with this indirect method than with the direct one. (4) VSL estimates depend on the injury used. More specifically, we obtained a lower VSL when a more severe injury is used. (5) Framing the risk of death in the modified standard gamble question as 10n in 10,000 instead of n in 1000 influences the value of VSL. We attribute this effect to the Ratio Bias.
Authors:
Vallejo-Torres, L. (Autor de correspondencia); García-Lorenzo, B.; Rivero-Arias, O. ; et al.
Journal:
EUROPEAN JOURNAL OF HEALTH ECONOMICS
ISSN:
1618-7598
Year:
2020
Vol.:
21
N°:
3
pp.
363 - 379
There is an extensive body of empirical research that focuses on the societal monetary value of a quality-adjusted life year (MVQALY). Many of these studies have found the estimates to be inversely associated with the size of the health gain, and thus not conforming to the linearity assumption imposed in the QALY model. In this study, we explore the extent to which the MVQALY varies when it is associated with different types and magnitudes of quality of life (QoL) improvements. To allow for a comprehensive assessment, we derive the MVQALY corresponding to the full spectrum of health gains defined by the EQ-5D-3L instrument. The analysis was based on a large and representative sample of the population in Spain. A discrete choice experiment and a time trade-off exercise were used to derive a value set for utilities, followed by a willingness to pay questionnaire. The data were jointly analysed using regression analyses and bootstrapping techniques. Our findings indicate that societal values for a QALY corresponding to different EQ-5D-3L health gains vary approximately between 10,000euro and 30,000euro. MVQALY associated with larger improvements on QoL was found to be lower than that associated with moderate QoL gains. The potential sources of the observed non-constant MVQALY are discussed.
Authors:
Sacristan, J. A. (Autor de correspondencia); Oliva, J. ; Campillo-Artero, C.; et al.
Journal:
GACETA SANITARIA
ISSN:
0213-9111
Year:
2020
Vol.:
34
N°:
2
pp.
189 - 193
Fifteen years ago, GACETA SANITARIA published the article entitled "What is an efficient health technology in Spain?"The growing interest in setting the price of new technologies based on the value they provide to health systems and the experience accumulated by the countries in our environment make it opportune to review what constitutes an efficient health intervention in Spain in 2020. Cost-effectiveness analysis continues to be the reference method to maximize social health outcomes with the available resources. The interpretation of its results requires establishing reference values that serve as a guide on what constitutes a reasonable value for the health care system. Efficiency thresholds must be flexible and dynamic, and they need to be updated periodically. Its application should be based on and transparency, and consider other factors that reflect social preferences. Although setting thresholds is down to political decision-makers, in Spain it could be reasonable to use thresholds of 25,000 and 60,000 Euros per QALY. However, currently, in addition to determining exact figures for the threshold, the key question is whether the Spanish National Health System is able and willing to implement a payment model based on value, towards achieving gradual financing decisions and, above all, to improve the predictability, consistency and transparency of the process. (C) 2019 SESPAS. Published by Elsevier Espana, S.L.U.
Authors:
Spencer, A. (Autor de correspondencia); Tomeny, E. ; Mujica-Mota, R. E.; et al.
Journal:
EUROPEAN JOURNAL OF HEALTH ECONOMICS
ISSN:
1618-7598
Year:
2019
Vol.:
20
N°:
4
pp.
559 - 568
Previous research has shown that demographics, beliefs, and self-reported own health influence TTO values. Our hypothesis is that attitudes towards length and quality of life influence TTO values, but should no longer affect a set of related choices that are based on respondents' own TTO scores. A representative sample of 1339 respondents was asked their level of agreement to four statements relating to the importance of quality and length of life. Respondents then went on to value 4 EQ-5D 5L states using an online interactive survey and a related set of 6 pairwise health-related choice questions, set up, so that respondents should be indifferent between choice options. We explored the impact of attitudes using regression analysis for TTO values and a logit model for choices. TTO values were correlated with the attitudes and were found to have a residual impact on the choices. In particular, those respondents who preferred quality of life over length of life gave less weight to the differences in years and more weight to differences in quality of life in these choice. We conclude that although the TTO responses reflect attitudes, these attitudes continue to affect health-related choices.
Authors:
Rodriguez-Miguez, E. (Autor de correspondencia); Pinto, José Luis; Mosquera-Nogueira, J.
Journal:
VALUE IN HEALTH
ISSN:
1098-3015
Year:
2019
Vol.:
22
N°:
4
pp.
446 - 452
Background: Paired-gamble methods have been proposed to avoid the "certainty effect" associated with standard gamble methods. Objective: This study examines the role of starting-point effects in paired-gamble methods. In particular, it examines how the utilities so derived vary as a function of the probabilities of the stimulus lottery. Methods: A sample of 455 members of the Spanish general population valued 9 health states via face-to-face interviews. Subjects were randomly placed into 3 subgroups, which differed in terms of the stimulus gamble's probability. Nonparametric tests and an interval regression model were used to test if utilities change when the probability distribution is modified. Results: Nonparametric tests showed that the probability of a health state being considered worse than death did not differ among subgroups. Nevertheless, changes in the stimulus gamble did produce significant differences in the distribution of utilities: the higher the probability of full health in the stimulus, the higher the utility elicited. Regression estimates support the existence of starting-point effects when the utilities are obtained under expected utility. According to the prospect theory, the conclusions depend on the reference point considered. When the reference points used are death or the health state evaluated, we observe differences among these groups. Nevertheless, when full health is used, these differences disappear. Conclusion: This research suggests that paired-gamble methods may also be susceptible to starting-point effects. Yet the differences are small, and they disappear when the data are analyzed using prospect theory with full health as the reference point. Copyright (C) 2019, ISPOR-The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc.
Authors:
Pinto, José Luis; McHugh, N. (Autor de correspondencia); Donaldson, C.; et al.
Journal:
HEALTH ECONOMICS
ISSN:
1057-9230
Year:
2019
Vol.:
28
N°:
11
pp.
1308 - 1319
Authors:
Blanco, M. V. A. (Autor de correspondencia); Brey, R.; Arana, J.; et al.
Journal:
EUROPEAN JOURNAL OF HEALTH ECONOMICS
ISSN:
1618-7598
Year:
2018
Vol.:
19
N°:
3
pp.
315 - 325
This study presents evidence on the role of emotions in the monetary evaluation of health technologies, namely, drug-eluting stents (DES) in our case. It is shown that subjects who are very afraid of having to undergo an angioplasty are: (a) less sensitive to the size of the risk reduction provided by DES and (b) willing to pay more. The lack of scope sensitivity questions the normative validity of the responses of highly emotional subjects. We provide evidence of this effect using what we call the cognitive-emotional random utility model and the responses of a face-to-face, computer-assisted personal interview survey conducted in a representative sample of the Spanish general population (n = 1663).
Authors:
Ramos-Goni, J. M. (Autor de correspondencia); Craig, B. M.; Oppe, M.; et al.
Journal:
VALUE IN HEALTH
ISSN:
1098-3015
Year:
2018
Vol.:
21
N°:
5
pp.
596 - 604
Background: The Spanish five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) valuation study was the first to use the EuroQol Valuation Technology protocol, including composite time trade-off (C-TTO) and discrete choice experiments (DCE). In this study, its investigators noticed that some interviewers did not fully explain the C-TTO task to respondents. Evidence from a follow-up study in 2014 confirmed that when interviewers followed the protocol, the distribution of C-TTO responses widened. Objectives: To handle the data quality issues in the C-TTO responses by estimating a hybrid interval regression model to produce a Spanish EQ-5D-5L value set. Methods: Four different models were tested. Model 0 integrated C-TTO and DCE responses in a hybrid model and models 1 to 3 altered the interpretation of the C-TTO responses: model 1 allowed for censoring of the C-TTO responses, whereas model 2 incorporated interval responses and model 3 included the interviewer-specific protocol violations. For external validation, the predictions of the four models were compared with those of the follow-up study using the Lin's concordance correlation coefficient. Results: This stepwise approach to modeling C-TTO and DCE responses improved the concordance between the valuation and follow-up studies (concordance correlation coefficient: 0.948 [model 0], 0.958 [model 1], 0.952 [model 2], and 0.989 [model 3]). We recommend the estimates from model 3, because its hybrid interval regression model addresses the data quality issues found in the valuation study. Conclusions: Protocol violations may occur in any valuation study; handling them in the analysis can improve external validity. The resulting EQ-5D-5L value set (model 3) can be applied to inform Spanish health technology assessments.
Authors:
Attema, A. E. (Autor de correspondencia); Brouwer, W. B. F. ; Pinto, José Luis
Journal:
HEALTH AND QUALITY OF LIFE OUTCOMES
ISSN:
1477-7525
Year:
2018
Vol.:
16
N°:
1
pp.
148 - 156
Background: Most health valuation studies assume that individuals' health valuations do not depend on social comparisons. However, there is some evidence that this assumption is not satisfied in practice. This paper tests whether self-rated health by means of a Visual Analogue Scale (VAS) is related to how one perceives the health of one's contemporaries, while accounting for one's health as classified by the EQ-5D classification system. Methods: In a large sample (n = 1500), representative of the general public, we use a VAS to rate respondents' own health and their assessment of their contemporaries' health. In addition, we directly ask them whether they perceive their health to be better, the same, or worse than their contemporaries, and we measure their own health according to the EQ-5D-5 L Results: We find a positive relationship between own health rating and contemporaries' health rating, after controlling for the respondents' own health as classified according to the EQ-5D. Furthermore, we observe a discrepancy between relative health vis-a-vis age peers as measured by an ordinal comparison and relative health as measured by a VAS. Finally, respondents, especially women, tended to overestimate the health of other people of their age. Conclusions: We provide evidence that people's own health rating is related to the perception of health of contemporaries. Our results indicate that knowledge about a respondent's perception of others' health is useful in explaining health state valuations.
Authors:
Pinto, José Luis; Sanchez-Martinez, F. I. (Autor de correspondencia); Abellan-Perpinan, J. M.; et al.
Journal:
HEALTH ECONOMICS
ISSN:
1057-9230
Year:
2018
Vol.:
27
N°:
8
pp.
1230 - 1246
Preferences elicited with matching and choice usually diverge (as characterised by preference reversals), violating a basic rationality requirement, namely, procedure invariance. We report the results of an experiment that shows that preference reversals between matching (Standard Gamble in our case) and choice are reduced when the matching task is conducted using nontransparent methods. Our results suggest that techniques based on nontransparent methods are less influenced by biases (i.e., compatibility effects) than transparent methods. We also observe that imprecision of preferences influences the degree of preference reversals. The preference reversal phenomenon is less strong in subjects with more precise preferences.
Authors:
Valenti, V. (Autor de correspondencia); Ramos, J.; Perez, C. ; et al.
Journal:
JOURNAL OF COMMUNITY AND SUPPORTIVE ONCOLOGY
ISSN:
2330-7749
Year:
2017
Vol.:
15
N°:
5
pp.
E256 - E262
Background Treatment-related adverse events (AEs) have a negative impact on the quality of life (QoL) of cancer patients. Patient and general public views can help in the investigation of patient needs and preferences. Objective To compare the impact on QoL reported by cancer patients who have experienced a particular AE with that envisioned by general public participants (hypothetical patients) who have not experienced AEs. Methods Five AEs were selected: total alopecia (Common Terminology Criteria for Adverse Events [CTCAE] grade 2), acneiform rash (CTCAE, grade 1 and grades 2-4), oxaliplatin-associated peripheral neuropathy (oxaliplatin-specific scale, grades 1, 2, and 4); diarrhea and vomiting (CTCAE, grades 1-2 and grades 3-4), resulting in 10 toxicity variables. Cancer patients and general public participants completed the Visual Analog Scale (VAS; 0 = poorest QoL; 100 = better QoL), and cancer patients also completed the EQ-5D-5L questionnaire (full range for Spanish population, -0.654-1.000). Results 246 general public participants and 200 toxic events in 139 cancer patients were analyzed. For all 10 endpoints, the mean VAS was higher for patients than for the general public participants. That difference was statistically significant (Mann-Withney U test) for all endpoints except for grade 1 neuropathy and grade 1 rash. For both groups, alopecia had a lower impact on quality of life than did severe rash (mean VAS for patients, 77 [alopecia] vs 59 [rash], compared with 55 vs 47, respectively, for the general public group). There was a positive linear correlation between the EQ-5D-5L and VAS (Spearman rho, 0.681; P = .001). Limitations Patients were asked to score AEs as separate and encapsulated from other concurrent symptoms. This exercise may be rather difficult for patients. Conclusions The impact of therapy-related AEs on QoL was lower in patients who have experienced the AEs than it was for the general public participants who had not experienced the AEs. The EQ-5D-5L is a useful tool for evaluating AEs. Funding/sponsorship Provided by the Oncologic Association Dr Amadeu Pelegri (AODAP), a charitable organization led by cancer patients and based in Salou, Spain.
Journal:
EUROPEAN JOURNAL OF HEALTH ECONOMICS
ISSN:
1618-7598
Year:
2017
Vol.:
18
N°:
7
pp.
921 - 932
We provide more evidence on the functional relationship between willingness-to-pay for risk reductions and age (the senior discount). We overcome many of the limitations of previous literature that has dealt with this issue, namely, the influence of the assumptions used in statistical models on the final results. Given our large sample size (n = 6024) we can use models that are very demanding on data. We use parametric (linear, quadratic, dummies), semi-nonparametric, and non-parametric models. We also compare the marginal and the total approach and show that they provide similar results. We also overcome one of the limitations of the total approach, that is, we include the effects of socioeconomic characteristics that are correlated with age (education and income). Our main result is that all these different approaches produce very similar results, namely, they show an inverted-U relation between the value of a statistical life (VSL) and age. Those results can hardly be attributed to problems of collinearity, omitted variables or statistical assumptions. We find a clear senior discount effect. This effect seems concentrated on those who have lower education and income levels. We also find that the value of a statistical life year (VSLY) increases with age.
Journal:
MEDICAL DECISION MAKING
ISSN:
0272-989X
Year:
2017
Vol.:
37
N°:
3
pp.
273 - 284
There is recent interest in using discrete choice experiments (DCEs) to derive health state utility values, and results can differ from time tradeoff (TTO). Clearly, DCE is "choice based,'' whereas TTO is generally considered a "matching'' task. We explore whether procedural adaptations to the TTO, which make the method more closely resemble a DCE, make TTO and choice converge. In particular, we test whether making the matching procedure in TTO less "transparent'' to the respondent reduces disparities between TTO and DCE. We designed an interactive survey that was hosted on the Internet, and 2022 interviews were achieved in the United Kingdom in a representative sample of the population. We found a marked divergence between TTO and DCE, but this was not related to the "transparency'' of the TTO procedure. We conclude that a difference in the error structure between TTO and choice and that factors other than differences in utility are affecting choices is driving the divergence. The latter has fundamental implications for the way choice data are analyzed and interpreted.
Authors:
Pinto, José Luis; Robles-Zurita, J. A. (Autor de correspondencia); Sanchez-Martinez, F. I.; et al.
Journal:
HEALTH ECONOMICS
ISSN:
1057-9230
Year:
2017
Vol.:
26
N°:
12
pp.
E304 - E318
We present data of a contingent valuation survey, testing the effect of evaluation mode on the monetary valuation of preventing road accidents. Half of the interviewees was asked to state their willingness to pay (WTP) to reduce the risk of having only 1 type of injury (separate evaluation, SE), and the other half of the sample was asked to state their WTP for 4 types of injuries evaluated simultaneously (joint evaluation, JE). In the SE group, we observed lack of sensitivity to scope while in the JE group WTP increased with the severity of the injury prevented. However, WTP values in this group were subject to context effects. Our results suggest that the traditional explanation of the disparity between SE and JE, namely, the so-called evaluability, does not apply here. The paper presents new explanations based on the role of preference imprecision.
Authors:
Attema, A. E. (Autor de correspondencia); Brouwer, W.B.F.; l¿Haridon, O.; et al.
Journal:
JOURNAL OF HEALTH ECONOMICS
ISSN:
0167-6296
Year:
2016
Vol.:
48
pp.
121 - 134
This paper performs several tests of decision analysis applied to the health domain. First, we conduct a test of the normative expected utility theory. Second, we investigate the possibility to elicit the more general prospect theory. We observe risk aversion for gains and losses and violations of expected utility. These results imply that mechanisms governing decisions in the health domain are similar to those in the monetary domain. However, we also report one important deviation: utility is universally concave for the health outcomes used in this study, in contrast to the commonly found S-shaped utility for monetary outcomes, with concave utility for gains and convex utility for losses.
Journal:
MEDICAL DECISION MAKING
ISSN:
0272-989X
Year:
2015
Vol.:
35
N°:
3
pp.
305 - 315
Authors:
Attema, A. E. (Autor de correspondencia); Brouwer, W. B. F.; l'Haridon, O.; et al.
Journal:
JOURNAL OF HEALTH ECONOMICS
ISSN:
0167-6296
Year:
2015
Vol.:
43
pp.
229 - 243
This paper is the first to apply prospect theory to societal health-related decision making. In particular, we allow for utility curvature, equity weighting, sign-dependence, and loss aversion in choices concerning quality of life of other people. We find substantial inequity aversion, both for gains and losses, which can be attributed to both diminishing marginal utility and differential weighting of better-off and worse-off. There are also clear framing effects, which violate expected utility. Moreover, we observe loss aversion, indicating that subjects give more weight to one group's loss than another group's gain of the same absolute magnitude. We also elicited some information on the effect of the age of the studied group. The amount of inequity aversion is to some extent influenced by the age of the considered patients. In particular, more inequity aversion is observed for gains of older people than gains of younger people.
Journal:
MANAGEMENT SCIENCE
ISSN:
0025-1909
Year:
2014
Vol.:
60
N°:
5
pp.
1346 - 1350
We present examples of existing evidence that lead us to be cautious about claims made in the original paper [Blavatskyy PR (2011) A model of probabilistic choice satisfying first-order stochastic dominance. Management Sci. 57(3):542¿548] that the proposed model provides a better fit to experimental data than do existing models. We raise concerns about the accuracy of this and other assertions and about the adequacy of the comparisons made with alternative models in the existing literature.
Journal:
SOCIAL SCIENCE AND MEDICINE
ISSN:
0277-9536
Year:
2014
Vol.:
113
pp.
5 - 14
Journal:
BRITISH MEDICAL BULLETIN
ISSN:
0007-1420
Year:
2012
Vol.:
103
N°:
1
pp.
5 - 20
Objective: This review examines the impact of economic evaluation in informing national or local policies within both jurisdictions. We focus on the factors that have made the economic evaluation evolves differently in both settings. Areas of agreement:
Economic evaluation facilitates decision-making regarding the efficiency of interventions. The existence of national or local bodies regulating the process has contributed to increasing its use in decision-making and the development of its methods. Areas of controversy: Cost-effectiveness approach is based on the assumption of health maximization subject to a budget constraint. Decision-makers are not only interested in health maximization alone. This may result in policy-makers failing to consider economic evaluations into their allocation decisions. Areas to develop research: Methods that incorporate wider decision-makers goals (mainly local) and research to study the real impact of economic evaluation in terms of improved efficiency and equity are particularly required.
Journal:
SOCIAL CHOICE AND WELFARE
ISSN:
0176-1714
Year:
2012
Vol.:
38
N°:
4
pp.
569 - 584
Revealed preferences are not consistent. Many anomalies have been found in different contexts. This finding leads to a divergence between normative and descriptive analyses. There are several ways of facing this problem. In this paper we argue in favour of debiasing observed choices in such a way that the ¿true¿ preferences are discovered. Our procedure is based on quantitative corrections derived from assuming the descriptive validity of prospect theory and the normative validity of expected utility theory. Those corrective formulas were first applied by Bleichrodt et al. (Manag Sci 47:1498¿1514, 2001). We explain here how such formulas can be used to avoid inefficient allocation of health care resources. This approach shares the philosophy of libertarian paternalism (LP). However, it reduces some of the potential problems of LP: the definition of error (and the need to nudge people) is more clear and objective. In this sense, it reduces the chances that the regulator tries to nudge people toward behaviour based on her preferences rather than those of the people she is nudging.
Authors:
Donaldson, C. (Autor de correspondencia); Baker, R.; Mason, H.; et al.
Journal:
BMC HEALTH SERVICES RESEARCH
ISSN:
1472-6963
Year:
2011
Vol.:
11
pp.
1 - 8
Journal:
JOURNAL OF ENVIRONMENTAL ECONOMICS AND MANAGEMENT
ISSN:
0095-0696
Year:
2010
Vol.:
59
N°:
3
pp.
271 - 285
This paper investigates whether responses to choice experiments (CEs) are subject to ordering anomalies. While previous research has focussed on the possibility that such anomalies relate to position in the sequence of choice tasks, our research reveals that the particular order of tasks matters. Using a novel experimental design that allows us to test our hypotheses using simple nonparametric statistics, we observe ordering anomalies in CE data similar to those recorded in the dichotomous choice contingent valuation literature. Those ordering effects operate in both price and commodity dimensions and are observed to compound over a series of choice tasks. Our findings cast serious doubt on the current practice of asking each respondent to undertake several choice tasks in a CE while treating each response as an independent observation on that individual's preferences.
Authors:
Baker, R.; Donaldson, C.; Lancsar, E.; et al.
Journal:
HEALTH TECHNOLOGY ASSESSMENT
ISSN:
1366-5278
Year:
2010
Vol.:
14
N°:
27
pp.
i - 161
