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Complex Valuation: Applying Ideas from the Complex Intervention Framework to Valuation of a New Measure for End-of-Life Care


  • Joanna Coast

    (University of Bristol)

  • Elisabeth Huynh

    (University of South Australia)

  • Philip Kinghorn

    (University of Bristol)

  • Terry Flynn

    (TF Choices Ltd)


Background The UK Medical Research Council approach to evaluating complex interventions moves through development, feasibility, piloting, evaluation and implementation in an iterative manner. This approach might be useful as a conceptual process underlying complex valuation tasks. Objective The objective of the study was to explore the applicability of such a framework using a single case study (valuing the ICECAP-Supportive Care Measure) and considering three key uncertainties: the number of response categories for the measure; experimental design; and the potential for using slightly different variants of the measure with the same value set. Methods Three on-line pilot studies (n = 204, n = 100, n = 102) were undertaken during 2012 and 2013 with adults from the UK general population. Each used variants of discrete choice and best-worst scaling tasks; respondents were randomly allocated to different groups to allow exploration of the number of levels for the instrument (four or five), optimal experimental design and the values for alternative wording around prognosis. Conditional logit regression models were used in the analysis and variance scale factors were explored. Results The five-level version of the measure seemed to result in simplifying heuristics. Plotting the variance scale factors suggested that best-worst scaling answers were approximately four times more consistent than the discrete choice answers. The likelihood ratio test indicated there was virtually no difference in values between the differently worded versions. Conclusion Rigorous piloting can improve the design of valuation studies. Thinking in terms of a ‘complex valuation framework’ may emphasise the importance of conducting and funding such rigorous pilots.

Suggested Citation

  • Joanna Coast & Elisabeth Huynh & Philip Kinghorn & Terry Flynn, 2016. "Complex Valuation: Applying Ideas from the Complex Intervention Framework to Valuation of a New Measure for End-of-Life Care," PharmacoEconomics, Springer, vol. 34(5), pages 499-508, May.
  • Handle: RePEc:spr:pharme:v:34:y:2016:i:5:d:10.1007_s40273-015-0365-9
    DOI: 10.1007/s40273-015-0365-9

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    References listed on IDEAS

    1. Terry N. Flynn & Elisabeth Huynh & Tim J. Peters & Hareth Al‐Janabi & Sam Clemens & Alison Moody & Joanna Coast, 2015. "Scoring the Icecap‐a Capability Instrument. Estimation of a UK General Population Tariff," Health Economics, John Wiley & Sons, Ltd., vol. 24(3), pages 258-269, March.
    2. Coast, Joanna & Smith, Richard D. & Lorgelly, Paula, 2008. "Welfarism, extra-welfarism and capability: The spread of ideas in health economics," Social Science & Medicine, Elsevier, vol. 67(7), pages 1190-1198, October.
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    Cited by:

    1. Jennifer A. Whitty & Ana Sofia Oliveira Gonçalves, 2018. "A Systematic Review Comparing the Acceptability, Validity and Concordance of Discrete Choice Experiments and Best–Worst Scaling for Eliciting Preferences in Healthcare," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 11(3), pages 301-317, June.
    2. Aizaki, Hideo & Fogarty, James, 2019. "An R package and tutorial for case 2 best–worst scaling," Journal of choice modelling, Elsevier, vol. 32(C), pages 1-1.
    3. Jeff Round & Mike Paulden, 2018. "Incorporating equity in economic evaluations: a multi-attribute equity state approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(4), pages 489-498, May.
    4. Huynh, Elisabeth & Coast, Joanna & Rose, John & Kinghorn, Philip & Flynn, Terry, 2017. "Values for the ICECAP-Supportive Care Measure (ICECAP-SCM) for use in economic evaluation at end of life," Social Science & Medicine, Elsevier, vol. 189(C), pages 114-128.
    5. Nikki McCaffrey & Simon Eckermann, 2018. "Raise the Bar, Not the Threshold Value: Meeting Patient Preferences for Palliative and End-of-Life Care," PharmacoEconomics - Open, Springer, vol. 2(2), pages 93-95, June.

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