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Discrepancies between Chained and Classic Utilities Induced by Anchoring with Occasional Adjustments

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  • Peep F. M. Stalmeier

    (Nijmegen Institute for Cognition and Information, Nijmegen; the Joint Center for Radiation Oncology Arnhem-Nijmegen, University Medical Center Nijmegen; and Medical Psychology, Academic Medical Center, Amsterdam)

Abstract

Background . Classic utility assessment uses death and perfect health as end points. Chained utility assessment uses other health states as end points. It has been previously noted that these 2 assessment procedures lead to different utilities. Purpose . The author attempts to explain these discrepancies between chained and classic assessments. Method . Previous data are plotted in a uniform way to facilitate comparison. Using time trade-off and paired-comparison data, the author estimates the extent to which respondents adjust their responses when end points are varied. Data were obtained in various samples: in healthy volunteers from the general public, in students, and in women at high risk for breast cancer seeking genetic counseling. Results . The author obtained 741 valid data records from a total of 106 participants. The data replicate the pattern found previously. When compared to classic utilities, (1) chained utilities are smaller (larger) when the best (worst) end point varies and (2) the discrepancies become smaller for utilities near 0 and 1. The data reveal that there is a distinct failure to adjust responses when the end points are varied, as if the responses anchor on some master health scale. The latter finding explains the robust pattern of discrepancies. Conclusion . Decision analyses that use a mix of classic and chained utilities are not on firm ground. One should be wary of normative interpretations of new value assessment procedures. Alternative interpretations of the findings are discussed.

Suggested Citation

  • Peep F. M. Stalmeier, 2002. "Discrepancies between Chained and Classic Utilities Induced by Anchoring with Occasional Adjustments," Medical Decision Making, , vol. 22(1), pages 53-64, February.
    • Handle: RePEc:sae:medema:v:22:y:2002:i:1:p:53-64
    DOI: 10.1177/0272989X0202200105
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    References listed on IDEAS

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    1. Pinto-Prades, Jose Luis & Loomes, Graham & Brey, Raul, 2009. "Trying to estimate a monetary value for the QALY," Journal of Health Economics, Elsevier, vol. 28(3), pages 553-562, May.
    2. Bleichrodt, Han & Pinto, Jose Luis & Maria Abellan-Perpinan, Jose, 2003. "A consistency test of the time trade-off," Journal of Health Economics, Elsevier, vol. 22(6), pages 1037-1052, November.
    3. P. Stalmeier & A. Verheijen, 2013. "Maximal endurable time states and the standard gamble: more preference reversals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(6), pages 971-977, December.
    4. 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.
    5. Paul McNamee & Sharon Glendinning & Jonathan Shenfine & Nick Steen & S. Griffin & John Bond, 2004. "Chained time trade-off and standard gamble methods," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 5(1), pages 81-86, February.
    6. Kristina Boye & Louis Matza & Kimberly Walter & Kate Brunt & Andrew Palsgrove & Aodan Tynan, 2011. "Utilities and disutilities for attributes of injectable treatments for type 2 diabetes," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(3), pages 219-230, June.
    7. Chen Li & Zhihua Li & Peter Wakker, 2014. "If nudge cannot be applied: a litmus test of the readers’ stance on paternalism," Theory and Decision, Springer, vol. 76(3), pages 297-315, March.

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