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Lack of multiplicative transitivity in person trade-off responses

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  • Micha�l Schwarzinger
  • Jean-Louis Lano�

    (Institut National de la Santé et de la Recherche Médicale, the Centre for Health Economics, H�pital de Bic�tre, Le Kremlin-Bic�tre, France)

  • Erik Nord

    (Norwegian Institute of Public Health, Oslo, Norway)

  • Isabelle Durand-Zaleski

    (Service de Santé Publique, H�pital Henri Mondor, Créteil, France)

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    Abstract

    Background: The person trade-off (PTO) is a technique for eliciting preferences for resource allocation across patient groups. In principle PTO responses should satisfy a requirement of multiplicative transitivity, i.e. that if people consider treatment of 1 in state A to be equivalent to treating 10 in state B, and 1 in state B to be equivalent to 10 in state C, then they should find 1 in state A equivalent to 100 in state C. Earlier studies addressing labelled diseases (specific diagnoses), have shown multiplicative intransitivity of the PTO responses. Our purpose was to test multiplicative transitivity in the case of health states described with the EuroQol instrument only and to find a possible framing effect such as the number of persons in the reference intervention. Methods: Forty-four master degree students were asked to fill in a questionnaire addressing four chronic health states. Their task consisted in (1) ranking the states by severity, (2) valuing each of them by the means of the time trade-off, and (3) doing the PTO for all the 10 possible pairwise combinations of the four chronic states plus a fatal one. In a subsequent questionnaire the number of persons in the reference intervention in the PTO was increased from 10 to 100. Multiplicative transitivity was studied in subjects who demonstrated a willingness to trade off and consistency in ranking individual values. Results: None of the 39 subjects included satisfied a minimum multiplicative transitivity requirement in PTO responses. Internal consistency was not improved when the PTO involved health states close to each other in terms of severity, nor when the prevention of death was not the reference intervention. For the 22 subjects having answered both types of questionnaire, increasing the number of persons in the reference intervention did not improve multiplicative transitivity. Conclusions: The PTO holds promise as a useful method for determining social preferences for priority setting, inasmuch as it captures distributive concerns that individual utility techniques such as the time trade-off do not address. But the lack of multiplicative transitivity in PTO responses is unsatisfactory, and ways to reduce this problem need to be explored. Copyright © 2003 John Wiley & Sons, Ltd.

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    Bibliographic Info

    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 13 (2004)
    Issue (Month): 2 ()
    Pages: 171-181

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    Handle: RePEc:wly:hlthec:v:13:y:2004:i:2:p:171-181

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    Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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    1. John Brazier & Mark Deverill, 1999. "A checklist for judging preference-based measures of health related quality of life: Learning from psychometrics," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 8(1), pages 41-51.
    2. Raymond C.W. Hutubessy & Rob M.P.M. Baltussen & David B. Evans & Jan J. Barendregt & Christopher J.L. Murray, 2001. "Stochastic league tables: communicating cost-effectiveness results to decision-makers," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 10(5), pages 473-477.
    3. Brooks, Richard AU -, 1996. "EuroQol: the current state of play," Health Policy, Elsevier, Elsevier, vol. 37(1), pages 53-72, July.
    4. Ham, Chris, 1997. "Priority setting in health care: learning from international experience," Health Policy, Elsevier, Elsevier, vol. 42(1), pages 49-66, October.
    5. Nord, Erik, 1993. "Unjustified use of the quality of well-being scale in priority setting in Oregon," Health Policy, Elsevier, Elsevier, vol. 24(1), pages 45-53, April.
    6. Eva Rodr�guez-M�guez & José-Luis Pinto-Prades, 2002. "Measuring the social importance of concentration or dispersion of individual health benefits," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 11(1), pages 43-53.
    7. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 8(1), pages 25-39.
    8. Nord, Erik, 1993. "The trade-off between severity of illness and treatment effect in cost-value analysis of health care," Health Policy, Elsevier, Elsevier, vol. 24(3), pages 227-238, August.
    9. Kevin J. Boyle & Richard C. Bishop & Michael P. Welsh, 1985. "Starting Point Bias in Contingent Valuation Bidding Games," Land Economics, University of Wisconsin Press, vol. 62(2), pages 188-194.
    10. Andrew R. Willan & Bernie J. O'Brien, 1999. "Sample size and power issues in estimating incremental cost-effectiveness ratios from clinical trials data," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 8(3), pages 203-211.
    11. Alan Williams, 1997. "Intergenerational Equity: An Exploration of the 'Fair Innings' Argument," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 6(2), pages 117-132.
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    13. Christopher J.L. Murray & David B. Evans & Arnab Acharya & Rob M.P.M. Baltussen, 2000. "Development of WHO guidelines on generalized cost-effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 9(3), pages 235-251.
    14. Ubel, Peter A. & Loewenstein, George & Scanlon, Dennis & Kamlet, Mark, 1998. "Value measurement in cost-utility analysis: explaining the discrepancy between rating scale and person trade-off elicitations," Health Policy, Elsevier, Elsevier, vol. 43(1), pages 33-44, January.
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    Cited by:
    1. Lars Østerdal, 2009. "The lack of theoretical support for using person trade-offs in QALY-type models," The European Journal of Health Economics, Springer, Springer, vol. 10(4), pages 429-436, October.
    2. Emily Lancsar & Jordan Louviere, 2006. "Deleting 'irrational' responses from discrete choice experiments: a case of investigating or imposing preferences?," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 15(8), pages 797-811.
    3. Jeff Richardson & John McKie & Stuart Peacock & Angelo Iezzi, 2011. "Severity as an independent determinant of the social value of a health service," The European Journal of Health Economics, Springer, Springer, vol. 12(2), pages 163-174, April.
    4. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 8(1), pages 25-39.

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