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The Lead Time Trade-Off: The Case Of Health States Better Than Death


  • Jose Luis Pinto Prades

    () (Department of Economics, Universidad Pablo de Olavide)

  • Eva Rodriguez Miguez

    () (Department of Economics, Universidad de Vigo)


The Lead Time Trade-Off (L-TTO) is a variant of the TTO method that tries to overcome some of the problems of the most widely used method (Torrance, 1986) for health states worse than death (SWD). Theoretically, the new method reduces the problems that have been detected when researchers have elicited preferences for SWD. However, several questions remain to be clarified. One of them is the influence of this new method for states better than death (SBD). In this paper we try to shed some light on this issue using a split sample design (n=500). One subsample (n=188) was interviewed using L-TTO and the rest using the traditional TTO (T-TTO). Our results show that the L-TTO produces utilities that are consistently higher than the T-TTO for SBD. Furthermore, the higher the severity the higher the difference between both methods. Another finding is that the L-TTO seems to produce a lower number of SWD. This effect seems to be concentrated in the most severe health states. This implies a violation of additive separability, one of the cornerstones of the QALY model. Our data show that the L-TTO may be different from the T-TTO in more respects than those that were originally intended.

Suggested Citation

  • Jose Luis Pinto Prades & Eva Rodriguez Miguez, 2011. "The Lead Time Trade-Off: The Case Of Health States Better Than Death," Working Papers 11.10, Universidad Pablo de Olavide, Department of Economics.
  • Handle: RePEc:pab:wpaper:11.10

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    References listed on IDEAS

    1. Charles M. Harvey, 1986. "Value Functions for Infinite-Period Planning," Management Science, INFORMS, vol. 32(9), pages 1123-1139, September.
    2. Nancy J. Devlin & Aki Tsuchiya & Ken Buckingham & Carl Tilling, 2011. "A uniform time trade off method for states better and worse than dead: feasibility study of the ‘lead time’ approach," Health Economics, John Wiley & Sons, Ltd., vol. 20(3), pages 348-361, March.
    3. 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.
    4. 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.
    5. Torrance, George W., 1986. "Measurement of health state utilities for economic appraisal : A review," Journal of Health Economics, Elsevier, vol. 5(1), pages 1-30, March.
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    More about this item


    Lead Time Trade-Off; QALYs; Discounting; Additive Independece;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • D01 - Microeconomics - - General - - - Microeconomic Behavior: Underlying Principles

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