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Are QALYs based on time trade‐off comparable? – A systematic review of TTO methodologies

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  • Trude Arnesen
  • Mari Trommald

Abstract

A wide range of methods is used to elicit quality‐of‐life weights of different health states to generate ‘Quality‐adjusted life years’ (QALYs). The comparability between different types of health outcomes at a numerical level is the main advantage of using a ‘common currency for health’ such as the QALY. It has been warned that results of different methods and perspectives should not be directly compared in QALY league tables. But do we know that QALYs are comparable if they are based on the same method and perspective? The Time trade‐off (TTO) consists in a hypothetical trade‐off between living shorter and living healthier. We performed a literature review of the TTO methodology used to elicit quality‐of‐life weights for own, current health. Fifty‐six journal articles, with quality‐of‐life weights assigned to 102 diagnostic groups were included. We found extensive differences in how the TTO question was asked. The time frame varied from 1 month to 30 years, and was not reported for one‐fourth of the weights. The samples in which the quality‐of‐life weights were elicited were generally small with a median size of 53 respondents. Comprehensive inclusion criteria were given for half the diagnostic groups. Co‐morbidity was described in less than one‐tenth of the groups of respondents. For two‐thirds of the quality‐of‐life weights, there was no discussion of the influence of other factors, such as age, sex, employment and children. The different methodological approaches did not influence the TTO weights in a predictable or clear pattern. Whether or not it is possible to standardise the TTO method and the sampling procedure, and whether or not the TTO will then give valid quality‐of‐life weights, remains an open question. This review of the TTO elicited on own behalf, shows that limiting cost–utility analysis to include only quality life weights from one method and one perspective is not enough to ensure that QALYs are comparable. Copyright © 2004 John Wiley & Sons, Ltd.

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  • Trude Arnesen & Mari Trommald, 2005. "Are QALYs based on time trade‐off comparable? – A systematic review of TTO methodologies," Health Economics, John Wiley & Sons, Ltd., vol. 14(1), pages 39-53, January.
    • Handle: RePEc:wly:hlthec:v:14:y:2005:i:1:p:39-53
    DOI: 10.1002/hec.895
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    1. Arthur Attema & Werner Brouwer, 2012. "The way that you do it? An elaborate test of procedural invariance of TTO, using a choice-based design," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(4), pages 491-500, August.
    2. F. E. van Nooten & X. Koolman & W. B. F. Brouwer, 2009. "The influence of subjective life expectancy on health state valuations using a 10 year TTO," Health Economics, John Wiley & Sons, Ltd., vol. 18(5), pages 549-558, May.
    3. Bas Janssen & Mark Oppe & Matthijs Versteegh & Elly Stolk, 2013. "Introducing the composite time trade-off: a test of feasibility and face validity," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 5-13, July.
    4. José M. Labeaga & Xisco Oliver & Amedeo Spadaro, "undated". "Measuring Changes in Health Capital," Working Papers 2005-15, FEDEA.
    5. Julie Ratcliffe & Terry Flynn & Frances Terlich & Katherine Stevens & John Brazier & Michael Sawyer, 2012. "Developing Adolescent-Specific Health State Values for Economic Evaluation," PharmacoEconomics, Springer, vol. 30(8), pages 713-727, August.
    6. Arthur Attema & Yvette Edelaar-Peeters & Matthijs Versteegh & Elly Stolk, 2013. "Time trade-off: one methodology, different methods," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 53-64, July.
    7. Louis S. Matza & Kristina S. Boye & David H. Feeny & Lee Bowman & Joseph A. Johnston & Katie D. Stewart & Kelly McDaniel & Jessica Jordan, 2016. "The time horizon matters: results of an exploratory study varying the timeframe in time trade-off and standard gamble utility elicitation," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(8), pages 979-990, November.
    8. Louis Matza & Sandhya Sapra & John Dillon & Anupama Kalsekar & Evan Davies & Mary Devine & Jessica Jordan & Amanda Landrian & David Feeny, 2015. "Health state utilities associated with attributes of treatments for hepatitis C," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(9), pages 1005-1018, December.
    9. Fanni Rencz & Peep F. M. Stalmeier & Márta Péntek & Valentin Brodszky & Gábor Ruzsa & Lóránt Gönczi & Károly Palatka & László Herszényi & Eszter Schäfer & János Banai & Mariann Rutka & László Gulácsi , 2019. "Patient and general population values for luminal and perianal fistulising Crohn’s disease health states," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 91-100, June.
    10. Floortje Nooten & Jan Busschbach & Michel Agthoven & Job Exel & Werner Brouwer, 2018. "What should we know about the person behind a TTO?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(9), pages 1207-1211, December.
    11. Arthur E. Attema & Marieke Krol & Job Exel & Werner B. F. Brouwer, 2018. "New findings from the time trade-off for income approach to elicit willingness to pay for a quality adjusted life year," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(2), pages 277-291, March.
    12. Terry Flynn, 2010. "Using Conjoint Analysis and Choice Experiments to Estimate QALY Values," PharmacoEconomics, Springer, vol. 28(9), pages 711-722, September.
    13. Jeremy Chancellor & Samuel Aballéa & Alison Lawrence & Rob Sheldon & Sandrine Cure & Juliette Plun-Favreau & Nick Marchant, 2008. "Preferences of Patients with Diabetes Mellitus for Inhaled versus Injectable Insulin Regimens," PharmacoEconomics, Springer, vol. 26(3), pages 217-234, March.

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