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The impact of adding an extra dimension to a preference-based measure


  • Brazier, John
  • Rowen, Donna
  • Tsuchiya, Aki
  • Yang, Yaling
  • Young, Tracy A.


The ability to compare incremental changes in Quality Adjusted Life Years (QALYs) generated by different condition-specific preference-based measures (CSPBMs), or indeed between generic measures, is often criticised even where the valuation methods and source of values are the same. A key concern is the impact of excluding key dimensions from a descriptive system. This study examines the impact of adding a generic pain/discomfort dimension to a CSPBM, the AQL-5D (an asthma-specific CSPBM), by valuing samples of states from the AQL-5D with and without the new dimension using an interviewer administered time trade-off with a sample of the UK general public. 180 respondents provided 720 valuations for states with and without pain/discomfort. As expected the additional pain/discomfort dimension was found to have a significant and relatively large coefficient. More importantly for comparing changes in QALYs across populations the addition of pain/discomfort significantly impacts on the coefficients of the other dimensions and the degree of impact differs by dimension and severity level. The net effect on the utility value depends on the severity of their state: the addition of pain/discomfort at level 1 (no pain/discomfort) or 2 (moderate pain/discomfort) significantly increased the mean health state values in an asthma patient population; whereas level 3 pain/discomfort (extreme) reduced values. Comparability between measures requires that the impact of different dimensions on preferences is additive, whether or not they are included in the classification system. Our results cast doubt on this assumption, implying that the chosen measure must contain all important and relevant dimensions in its classification system.

Suggested Citation

  • Brazier, John & Rowen, Donna & Tsuchiya, Aki & Yang, Yaling & Young, Tracy A., 2011. "The impact of adding an extra dimension to a preference-based measure," Social Science & Medicine, Elsevier, vol. 73(2), pages 245-253, July.
  • Handle: RePEc:eee:socmed:v:73:y:2011:i:2:p:245-253

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    References listed on IDEAS

    1. Brazier, John & Ratcliffe, Julie & Salomon, Joshua & Tsuchiya, Aki, 2016. "Measuring and Valuing Health Benefits for Economic Evaluation," OUP Catalogue, Oxford University Press, edition 2, number 9780198725923, June.
    2. Julie Ratcliffe & John Brazier & Aki Tsuchiya & Tara Symonds & Martin Brown, 2009. "Using DCE and ranking data to estimate cardinal values for health states for deriving a preference-based single index from the sexual quality of life questionnaire," Health Economics, John Wiley & Sons, Ltd., vol. 18(11), pages 1261-1276.
    3. Brazier, John & Roberts, Jennifer & Deverill, Mark, 2002. "The estimation of a preference-based measure of health from the SF-36," Journal of Health Economics, Elsevier, vol. 21(2), pages 271-292, March.
    4. Christopher McCabe & Katherine Stevens & Jennifer Roberts & John Brazier, 2005. "Health state values for the HUI 2 descriptive system: results from a UK survey," Health Economics, John Wiley & Sons, Ltd., vol. 14(3), pages 231-244.
    5. Claire Gudex, 1994. "Time trade-off user manual: props and self-completion methods," Working Papers 020cheop, Centre for Health Economics, University of York.
    6. Keeney,Ralph L. & Raiffa,Howard, 1993. "Decisions with Multiple Objectives," Cambridge Books, Cambridge University Press, number 9780521438834, March.
    7. Jack Dowie, 2002. "Decision validity should determine whether a generic or condition-specific HRQOL measure is used in health care decisions," Health Economics, John Wiley & Sons, Ltd., vol. 11(1), pages 1-8.
    8. John Brazier & Aki Tsuchiya, 2010. "Preference-based condition-specific measures of health: what happens to cross programme comparability?," Health Economics, John Wiley & Sons, Ltd., vol. 19(2), pages 125-129.
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    Cited by:

    1. John Brazier & Jennifer Roberts & Donna Rowen, 2012. "Methods for Developing Preference-based Measures of Health," Chapters,in: The Elgar Companion to Health Economics, Second Edition, chapter 37 Edward Elgar Publishing.


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