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Revisiting United States valuation of EQ-5D states


  • Craig., Benjamin M.
  • Busschbach, Jan J.V.


In the original US valuation study of EQ-5D states, all worse-than-dead time trade-off responses (26% of the sample) were divided by 39 to increase the QALY estimates. This transformation has no theoretical justification and motivates this re-examination. Using the publically available dataset, we compared three alternative random utility models: instant (IRUM), angular (ARUM), and episodic (ERUM) models. Each leads to a distinct econometric estimator: mean ratio, ratio of means, and coefficient, respectively. IRUM suggests that 203 of the 243 EQ-5D states are worse-than-dead, which has little face validity compared to ARUM and ERUM (42 and 3 WTD states). ARUM and ERUM estimates are proportionally related such that losses in QALYs are approximately 37% larger under ARUM than ERUM. Compared to ERUM, economic evaluations using ARUM estimates emphasize quality of life, and this difference may influence policy decisions. Either ERUM or ARUM values sets are recommended over the original, transformed set.

Suggested Citation

  • Craig., Benjamin M. & Busschbach, Jan J.V., 2011. "Revisiting United States valuation of EQ-5D states," Journal of Health Economics, Elsevier, vol. 30(5), pages 1057-1063.
  • Handle: RePEc:eee:jhecon:v:30:y:2011:i:5:p:1057-1063
    DOI: 10.1016/j.jhealeco.2011.07.009

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    References listed on IDEAS

    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    2. Torrance, George W., 1976. "Social preferences for health states: An empirical evaluation of three measurement techniques," Socio-Economic Planning Sciences, Elsevier, vol. 10(3), pages 129-136.
    3. Han Bleichrodt, 2002. "A new explanation for the difference between time trade-off utilities and standard gamble utilities," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 447-456.
    4. Benjamin M. Craig, 2009. "The duration effect: a link between TTO and VAS values," Health Economics, John Wiley & Sons, Ltd., vol. 18(2), pages 217-225.
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    More about this item


    QALY; Time trade-off; Health-related quality of life;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General


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