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Is there a case for using visual analogue scale valuations in cost-utility analysis?

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  • David Parkin

    (City Health Economics Centre, City University, London, UK)

  • Nancy Devlin

    (City Health Economics Centre, City University, London, UK)

Abstract

This paper critically reviews theoretical and empirical propositions regarding visual analogue scale (VAS) valuations of health states and their use in cost-utility analysis (CUA). A widely repeated assertion in the economic evaluation literature is the inferiority, on theoretical grounds, of VAS valuations. Five common criticisms are: VAS lacks a theoretical foundation; VAS values are not 'choice based'; VAS values are not consistent with utility-under-uncertainty requirements; context and range effects observed in VAS valuation data mean that they cannot even be considered to represent measurable value functions; and when completing a VAS, people are not trying to express values. We address each of these points: the VAS does have a theoretical basis, being entirely consistent with the non-welfarist foundations of QALYs and CUA; the 'choiceless' nature of the VAS is incorrectly judged by stated preference criteria relevant to monetary rather than health state valuations, and VAS valuations do in any case involve an element of choice; because valuations are intended for use in social decision-making, it may be advantageous that VAS values are elicited under conditions of certainty; although there are measurement problems with the VAS, means such as better design and transformations of data can deal with these; and with any method of eliciting values, it is unrealistic to expect people consciously to think in terms of social science constructs such as utilities. Moreover, there are problems, both theoretical and empirical, with alternative methods. Selection of the appropriate valuation method should be based on empirical performance, and in this the VAS has important advantages. We conclude that there are strong grounds for disputing the consensus view against the VAS and challenge those who hold it to deploy more convincing arguments and evidence in favour of alternative methods. However, we identify areas where further research is required to establish and consolidate the potential of the VAS as a valuation method. Copyright © 2006 John Wiley & Sons, Ltd.

Suggested Citation

  • David Parkin & Nancy Devlin, 2006. "Is there a case for using visual analogue scale valuations in cost-utility analysis?," Health Economics, John Wiley & Sons, Ltd., vol. 15(7), pages 653-664.
  • Handle: RePEc:wly:hlthec:v:15:y:2006:i:7:p:653-664
    DOI: 10.1002/hec.1086
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    Cited by:

    1. 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.
    2. Hildegard Seidl & Matthias Hunger & Reiner Leidl & Christa Meisinger & Rupert Wende & Bernhard Kuch & Rolf Holle, 2015. "Cost-effectiveness of nurse-based case management versus usual care for elderly patients with myocardial infarction: results from the KORINNA study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(6), pages 671-681, July.
    3. Arthur E. Attema & Werner B.F. Brouwer, 2014. "Deriving Time Discounting Correction Factors For Tto Tariffs," Health Economics, John Wiley & Sons, Ltd., vol. 23(4), pages 410-425, April.
    4. Keith Tolley & Catherine Goad & Yunni Yi & Penny Maroudas & Amin Haiderali & Gwilym Thompson, 2013. "Utility elicitation study in the UK general public for late-stage chronic lymphocytic leukaemia," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(5), pages 749-759, October.
    5. Abellán Perpiñán, José Mª & Sánchez Martínez,Fernando I. & Martínez Pérez, Jorge E., 2007. "La medición del bienestar social relacionado con la salud/The Measurement of the Health Related Social Welfare," Estudios de Economía Aplicada, Estudios de Economía Aplicada, vol. 25, pages 927-950, Diciembre.
    6. Christine McDonough & Anna Tosteson, 2007. "Measuring Preferences for Cost-Utility Analysis," PharmacoEconomics, Springer, vol. 25(2), pages 93-106, February.
    7. Buckingham, K. & Devlin, N. & Tabberer, M., 2004. "A theoretical framework for TTO valuations and a taxonomy of TTO approaches: results from a pilot study," Working Papers 04/07, Department of Economics, City University London.
    8. Nancy Devlin & Paul Hansen & Peter Herbison & Susan Macran, 2005. "A ‘new and improved’ EQ-5D valuation questionnaire?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(1), pages 73-82, March.
    9. Ryan, Mandy & Kinghorn, Philip & Entwistle, Vikki A. & Francis, Jill J., 2014. "Valuing patients' experiences of healthcare processes: Towards broader applications of existing methods," Social Science & Medicine, Elsevier, vol. 106(C), pages 194-203.
    10. repec:spr:eujhec:v:19:y:2018:i:3:d:10.1007_s10198-017-0887-5 is not listed on IDEAS
    11. Hirsch Ruchlin & Ralph Insinga, 2008. "A Review of Health-Utility Data for Osteoarthritis," PharmacoEconomics, Springer, vol. 26(11), pages 925-935, November.
    12. repec:eee:socmed:v:189:y:2017:i:c:p:114-128 is not listed on IDEAS
    13. Bobinac, Ana & van Exel, N. Job A. & Rutten, Frans F.H. & Brouwer, Werner B.F., 2012. "GET MORE, PAY MORE? An elaborate test of construct validity of willingness to pay per QALY estimates obtained through contingent valuation," Journal of Health Economics, Elsevier, vol. 31(1), pages 158-168.
    14. repec:spr:eujhec:v:19:y:2018:i:2:d:10.1007_s10198-017-0883-9 is not listed on IDEAS
    15. Nord, Erik, 2012. "Measuring concerns for severity: Re-examination of a health scale with purported equal interval properties," Health Policy, Elsevier, vol. 105(2), pages 312-316.
    16. van den Berg, Bernard & Van Dommelen, Paula & Stam, Piet & Laske-Aldershof, Trea & Buchmueller, Tom & Schut, Frederik T., 2008. "Preferences and choices for care and health insurance," Social Science & Medicine, Elsevier, vol. 66(12), pages 2448-2459, June.
    17. Daniel M. Hausman, 2010. "Valuing health: a new proposal," Health Economics, John Wiley & Sons, Ltd., vol. 19(3), pages 280-296.
    18. Kyra Kneis & Afschin Gandjour, 2009. "Economic evaluation of Sinfrontal®in the treatment of acute maxillary sinusitis in adults," Applied Health Economics and Health Policy, Springer, vol. 7(3), pages 181-191, September.
    19. Devlin, N. & Shah, K. & Mulhern, B. & Pantiri, K. & van Hout, B., 2017. "A New Valuation Method: Directly Eliciting Personal Utility Functions," Research Papers 001885, Office of Health Economics.

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