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The European Journal of Health Economics
Published in: The European Journal of Health Economics 2/2019

Open Access 01-03-2019 | Original Paper

A new method for valuing health: directly eliciting personal utility functions

Authors: Nancy J. Devlin, Koonal K. Shah, Brendan J. Mulhern, Krystallia Pantiri, Ben van Hout

Published in: The European Journal of Health Economics | Issue 2/2019

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Abstract

Background

Standard methods for eliciting the preference data upon which ‘value sets’ are based generally have in common an aim to ‘uncover’ people’s preferences by asking them to evaluate a subset of health states, then using their responses to infer their preferences over all dimensions and levels. An alternative approach is to ask people directly about the relative importance to them of the dimensions, levels and interactions between them. This paper describes a new stated preference approach for directly eliciting personal utility functions (PUFs), and reports a pilot study to test its feasibility for valuing the EQ-5D.

Methods

A questionnaire was developed, designed to directly elicit PUFs from general public respondents via computer-assisted personal interviews, with a focus on helping respondents to reflect and deliberate on their preferences. The questionnaire was piloted in England.

Results

Seventy-six interviews were conducted in December 2015. Overall, pain/discomfort and mobility were found to be the most important of the EQ-5D dimensions. The ratings for intermediate improvements in each dimension show heterogeneity, both within and between respondents. Almost a quarter of respondents indicated that no EQ-5D health states are worse than dead.

Discussion

The PUF approach appears to be feasible, and has the potential to yield meaningful, well-informed preference data from respondents that can be aggregated to yield a value set for the EQ-5D. A deliberative approach to health state valuation also has the potential to complement and develop existing valuation methods. Further refinement of some elements of the approach is required.
Appendix
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Footnotes
1
A ‘feedback module’—recently incorporated into the EuroQol protocol for valuing EQ-5D-5L health states [12]—is a step in this direction although limited in that it only shows how the TTO health states have been ranked, not how the values themselves are interpreted and used to generate a utility function.
 
2
The rationale for this was that we considered the wording of the EQ-5D-5L labels to be more appropriate than those of the EQ-5D-3L labels (e.g. the 5L label for the worst mobility level—‘unable to walk about’ appears to be an improvement over the corresponding 3L label—‘confined to bed’ [27]), and that our ultimate ambition is to apply the method to generate utility functions for the EQ-5D-5L.
 
3
Mobility; self-care; usual activities; pain/discomfort; anxiety/depression.
 
4
This was a limitation with the (relatively rudimentary) Excel tool we developed for this study. If the PUF approach was to be taken forward, it would be a simple matter to automate this step, so that it is not subject to interviewer oversight.
 
5
For example, if mobility had a mean rating that was 25% of the sum of all five mean ratings, then MO level 3 would be given a mean decrement of 0.25 in Table 9.
 
6
For example, if the mean level 2 rating for mobility was 50, and the mobility level 3 decrement was 0.25, then the mobility level 2 decrement would be 0.25 * 0.5 = 0.125.
 
7
For example, if a respondent’s location of dead was found to lie between two health states which had 0–1 scale values of 0.45 and 0.55, then we would infer that their approximate location of dead is at 0.5. Since dead needs to be 0, all the decrements would be re-scaled accordingly. In the simple example of dead being re-scaled from 0.5 to 0, all of the decrements would double in size. Once this has been done for each respondent, Table 9 can be produced in a similar manner to Table 8.
 
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Metadata
Title
A new method for valuing health: directly eliciting personal utility functions
Authors
Nancy J. Devlin
Koonal K. Shah
Brendan J. Mulhern
Krystallia Pantiri
Ben van Hout
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 2/2019
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-018-0993-z

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