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Is there a case for using visual analogue scale valuations in cost-utility analysis?

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Author Info
David Parkin (City Health Economics Centre, City University, London, UK)
Nancy Devlin (City Health Economics Centre, City University, London, UK)

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Abstract

This paper critically reviews theoretical and empirical propositions regarding visual analogue scale (VAS) valuations of health states and their use in cost-utility analysis (CUA). A widely repeated assertion in the economic evaluation literature is the inferiority, on theoretical grounds, of VAS valuations. Five common criticisms are: VAS lacks a theoretical foundation; VAS values are not 'choice based'; VAS values are not consistent with utility-under-uncertainty requirements; context and range effects observed in VAS valuation data mean that they cannot even be considered to represent measurable value functions; and when completing a VAS, people are not trying to express values.

We address each of these points: the VAS does have a theoretical basis, being entirely consistent with the non-welfarist foundations of QALYs and CUA; the 'choiceless' nature of the VAS is incorrectly judged by stated preference criteria relevant to monetary rather than health state valuations, and VAS valuations do in any case involve an element of choice; because valuations are intended for use in social decision-making, it may be advantageous that VAS values are elicited under conditions of certainty; although there are measurement problems with the VAS, means such as better design and transformations of data can deal with these; and with any method of eliciting values, it is unrealistic to expect people consciously to think in terms of social science constructs such as utilities.

Moreover, there are problems, both theoretical and empirical, with alternative methods. Selection of the appropriate valuation method should be based on empirical performance, and in this the VAS has important advantages. We conclude that there are strong grounds for disputing the consensus view against the VAS and challenge those who hold it to deploy more convincing arguments and evidence in favour of alternative methods. However, we identify areas where further research is required to establish and consolidate the potential of the VAS as a valuation method. Copyright © 2006 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.1086
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Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 15 (2006)
Issue (Month): 7 ()
Pages: 653-664
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Handle: RePEc:wly:hlthec:v:15:y:2006:i:7:p:653-664

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Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. Nord, Erik, 1993. "The trade-off between severity of illness and treatment effect in cost-value analysis of health care," Health Policy, Elsevier, vol. 24(3), pages 227-238, August. [Downloadable!] (restricted)
  2. Torrance, George W., 1986. "Measurement of health state utilities for economic appraisal : A review," Journal of Health Economics, Elsevier, vol. 5(1), pages 1-30, March. [Downloadable!] (restricted)
  3. Stefan Björk & Anna Norinder, 1999. "The weighting exercise for the Swedish version of the EuroQol," Health Economics, John Wiley & Sons, Ltd., vol. 8(2), pages 117-126.
  4. Rachel Baker & Angela Robinson, 2004. "Responses to standard gambles: are preferences 'well constructed'?," Health Economics, John Wiley & Sons, Ltd., vol. 13(1), pages 37-48. [Downloadable!]
  5. Sen, Amartya K, 1977. "Social Choice Theory: A Re-examination," Econometrica, Econometric Society, vol. 45(1), pages 53-89, January. [Downloadable!] (restricted)
  6. Ken Buckingham & Nancy Devlin & Maggie Tabberer, 2004. "A theoretical framework for TTO valuations and a taxonomy of TTO approaches: results from a pilot study," City University Economics Discussion Papers 04/07, Department of Economics, City University, London. [Downloadable!]
  7. Nancy J. Devlin & Paul Hansen & Paul Kind & Alan Williams, 2003. "Logical inconsistencies in survey respondents' health state valuations - a methodological challenge for estimating social tariffs," Health Economics, John Wiley & Sons, Ltd., vol. 12(7), pages 529-544. [Downloadable!]
  8. Loomes, Graham & Sugden, Robert, 1982. "Regret Theory: An Alternative Theory of Rational Choice under Uncertainty," Economic Journal, Royal Economic Society, vol. 92(368), pages 805-24, December. [Downloadable!] (restricted)
  9. Kahneman, Daniel & Tversky, Amos, 1979. "Prospect Theory: An Analysis of Decision under Risk," Econometrica, Econometric Society, vol. 47(2), pages 263-91, March. [Downloadable!] (restricted)
  10. Culyer, A J, 1989. "The Normative Economics of Health Care Finance and Provision," Oxford Review of Economic Policy, Oxford University Press, vol. 5(1), pages 34-58, Spring.
  11. N J Devlin & P Hansen & P Kind & A H Williams, 2000. "The health state preferences and logistical inconsistencies of New Zealanders: a tale of two tariffs," Working Papers 180chedp, Centre for Health Economics, University of York. [Downloadable!]
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  1. Abellán Perpiñán, José Mª & Sánchez Martínez,Fernando I. & Martínez Pérez, Jorge E., 2007. "La medición del bienestar social relacionado con la salud/The Measurement of the Health Related Social Welfare," Estudios de Economía Aplicada, Estudios de Economía Aplicada, vol. 25, pages 823 - 24 , Diciembre. [Downloadable!] (restricted)
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