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Using a Discrete Choice Experiment to Value the EQ-5D-5L in Canada

This study explores the use of a discrete choice experiment (DCE) to value health states in Canada, alongside the Time Trade-Off (TTO) method. The aim is to develop an algorithm for a descriptive health classification system that reflects values from a representative sample of the general population. The study examines the engagement and understanding of the DCE and TTO tasks, the impact of exclusions on representativeness, and the differences in values between the two methods. Limitations and further investigations are also discussed.

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Using a Discrete Choice Experiment to Value the EQ-5D-5L in Canada

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  1. Using a Discrete Choice Experiment to Value the EQ-5D-5L in Canada Nick Bansback Assistant Professor School of Population and Public Health, University of British Columbia CIHR New Investigator

  2. Conflict of interest • Member of the EuroQol group • No conflicts related to this presentation

  3. National Health State Valuation Studies We want: • An algorithm for a descriptive health classification system • That reflect values from individuals that engage and understand the task • From a representative sample of general population

  4. How many people engage and understand the TTO? • We excluded 136 (11%) from the TTO analysis: • Illogical responses (e.g. value some pain better than no pain) • Implausible responses (e.g. value mild health states as worse than dead) • Untrustworthy responses (e.g. value a variety of health states the same)

  5. How many people engage and understand the TTO? Engel L. et al. Exclusion Criteria in National Health State Valuation Studies: a Systematic Review

  6. But did the rest really understand and engage? Values for all health states Values for health state 55555 N N

  7. Impact of exclusions on representativeness • In the wider literature, excluded persons tend to be older, less educated and sicker1 • Similar findings in our TTO study • Impact of exclusions on values varies between studies1 • Small differences (larger at more severe health states) found in our TTO study → the TTO task seems to lead to exclusions that might influence the representativeness and numbers in National Health State Valuation Studies 1. Engel L. et al. Exclusion Criteria in National Health State Valuation Studies: a Systematic Review

  8. Discrete choice experiment with a duration attribute (DCEtto) TTO DCEtto DCEttoRequires if health state A is preferred to B and not the degreeby which A is preferred to B

  9. Previous research in DCEtto Bansback, et al. "Using a discrete choice experiment to estimate health state utility values." Journal of health economics 31.1 (2012): 306-318. Bansback, et al. "Testing a discrete choice experiment including duration to value health states for large descriptive systems: Addressing design and sampling issues." Social Science & Medicine 114 (2014): 38-48.

  10. Canadian EQ-5D 5L study • Alongside the TTO, participants also completed between 7 and 9 DCEtto tasks (in 7 tasks duration was equal between options) • A total of 252 DCE unique pairs were valued – created using D-efficient designs • 1107 respondents – 19926 observations • Modelled using conditional logit model, interacting duration with each level of each EQ-5D dimension

  11. Differences in distribution of values Values for all health states Values for health state 55555 N N

  12. Differences in average values Utility values ←Better health states Worse health states→

  13. Impact of excluded respondents from TTO Utility values ←Better health states Worse health states→

  14. Limitations • Unclear whether the DCEtto really is simpler • Harder to test whether respondents have engaged and understood the task • Gives lower values than TTO – but these are not directly valued - difficult to know if they are real • …All questions currently being investigated in studies by our team and others

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