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The Lead Time Tradeoff

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  • José Luis Pinto-Prades
  • Eva Rodríguez-Míguez

Abstract

Background. Lead time tradeoff (L-TTO) is a variant of the time tradeoff (TTO). L-TTO introduces a lead period in full health before illness onset, avoiding the need to use 2 different procedures for states better and worse than dead. To estimate utilities, additive separability is assumed. We tested to what extent violations of this assumption can bias utilities estimated with L-TTO. Methods. A sample of 500 members of the Spanish general population evaluated 24 health states, using face-to-face interviews. A total of 188 subjects were interviewed with L-TTO and the rest with TTO. Both samples evaluated the same set of 24 health states, divided into 4 groups with 6 health states per set. Each subject evaluated 1 of the sets. A random effects regression model was fitted to our data. Only health states better than dead were included in the regression since it is in this subset where additive separability can be tested clearly. Results. Utilities were higher in L-TTO in relation to TTO (on average L-TTO adds about 0.2 points to the utility of health states), suggesting that additive separability is violated. The difference between methods increased with the severity of the health state. Thus, L-TTO adds about 0.14 points to the average utility of the less severe states, 0.23 to the intermediate states, and 0.28 points to the more severe estates. Conclusions. L-TTO produced higher utilities than TTO. Health problems are perceived as less severe if a lead period in full health is added upfront, implying that there are interactions between disjointed time periods. The advantages of this method have to be compared with the cost of modeling the interaction between periods.

Suggested Citation

  • José Luis Pinto-Prades & Eva Rodríguez-Míguez, 2015. "The Lead Time Tradeoff," Medical Decision Making, , vol. 35(3), pages 305-315, April.
    • Handle: RePEc:sae:medema:v:35:y:2015:i:3:p:305-315
    DOI: 10.1177/0272989X14541952
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    References listed on IDEAS

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    1. Nancy Devlin & Ken Buckingham & Koonal Shah & Aki Tsuchiya & Carl Tilling & Grahame Wilkinson & Ben van Hout, 2013. "A Comparison Of Alternative Variants Of The Lead And Lag Time Tto," Health Economics, John Wiley & Sons, Ltd., vol. 22(5), pages 517-532, May.
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    4. Angela Robinson & Anne Spencer, 2006. "Exploring challenges to TTO utilities: valuing states worse than dead," Health Economics, John Wiley & Sons, Ltd., vol. 15(4), pages 393-402, April.
    5. van der Pol, Marjon & Cairns, John, 2002. "A comparison of the discounted utility model and hyperbolic discounting models in the case of social and private intertemporal preferences for health," Journal of Economic Behavior & Organization, Elsevier, vol. 49(1), pages 79-96, September.
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