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A note on the nature of utility in time and health and implications for cost utility analysis

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  • Buckingham, Ken J.
  • Devlin, Nancy Joy

Abstract

Time Trade-Off (TTO) valuations of health are widely used in economic evaluation of health care. Current approaches to eliciting TTO values, and their use in economic evaluation, rest on specific assumptions about the way utility relates to time and health. Both the assumptions themselves and evidence of violations of them are discussed in the literature - yet the issues appear not to be widely appreciated by those using and applying TTO in economic evaluation. This paper adds to that literature by demonstrating both the requirements of TTO and violations of these assumptions in terms of the underlying indifference curve maps and utility functions. The advantage of this approach is that it demonstrates very clearly a number of fundamental problems for the way TTO values are currently elicited and used in cost utility analysis. In essence, it is extremely unwise to assume that the current 'tariffs' of TTO values, such as those widely used in cost utility analysis to inform health sector decisions in many countries can be applied irrespective of the duration of the health states to which they are assigned. The estimates of QALYs that result will, quite often, simply be wrong. We conclude by pointing to a number of possible solutions.

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  • Buckingham, Ken J. & Devlin, Nancy Joy, 2009. "A note on the nature of utility in time and health and implications for cost utility analysis," Social Science & Medicine, Elsevier, vol. 68(2), pages 362-367, January.
  • Handle: RePEc:eee:socmed:v:68:y:2009:i:2:p:362-367
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    Cited by:

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    2. Federico Augustovski & Lucila Rey-Ares & Vilma Irazola & Mark Oppe & Nancy Devlin, 2013. "Lead versus lag-time trade-off variants: does it make any difference?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 25-31, July.
    3. Nancy J. Devlin & Aki Tsuchiya & Ken Buckingham & Carl Tilling, 2011. "A uniform time trade off method for states better and worse than dead: feasibility study of the ‘lead time’ approach," Health Economics, John Wiley & Sons, Ltd., vol. 20(3), pages 348-361, March.
    4. Ariel Beresniak & Antonieta Medina-Lara & Jean Auray & Alain Wever & Jean-Claude Praet & Rosanna Tarricone & Aleksandra Torbica & Danielle Dupont & Michel Lamure & Gerard Duru, 2015. "Validation of the Underlying Assumptions of the Quality-Adjusted Life-Years Outcome: Results from the ECHOUTCOME European Project," PharmacoEconomics, Springer, vol. 33(1), pages 61-69, January.
    5. Sharma, Rajiv & Stano, Miron, 2010. "Implications of an economic model of health states worse than dead," Journal of Health Economics, Elsevier, vol. 29(4), pages 536-540, July.
    6. Cathrine Elgaard Jensen & Sabrina Storgaard Sørensen & Claire Gudex & Morten Berg Jensen & Kjeld Møller Pedersen & Lars Holger Ehlers, 2021. "The Danish EQ-5D-5L Value Set: A Hybrid Model Using cTTO and DCE Data," Applied Health Economics and Health Policy, Springer, vol. 19(4), pages 579-591, July.
    7. Papathanasopoulou, Eleni & White, Mathew P. & Hattam, Caroline & Lannin, Aisling & Harvey, Andrea & Spencer, Anne, 2016. "Valuing the health benefits of physical activities in the marine environment and their importance for marine spatial planning," Marine Policy, Elsevier, vol. 63(C), pages 144-152.

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