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Is Dimension Order Important when Valuing Health States Using Discrete Choice Experiments Including Duration?

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Abstract

Background

Discrete choice experiments with duration (DCETTO) can be used to estimate utility values for preference-based measures, such as the EQ-5D-5L. For self-completion, the health dimensions are presented in a standard order. However, for valuation, this may result in order effects. Thus, it is important to understand whether health state dimension ordering affects values. The aim of this study was to examine the importance of dimension ordering on DCE values using EQ-5D-5L.

Methods

A choice experiment presenting two health profiles and a third immediate death option was developed. A three-arm study was used, with the same 120 choice sets presented online across each arm (n = 360 per arm). Arm 1 presented the standard EQ-5D-5L dimension order, arm 2 randomised order between respondents, and arm 3 randomised within respondents. Conditional logit regression was used to assess model consistency, and scale parameter testing was used to assess model poolability.

Results

There were minor inconsistencies across each arm, but the magnitudes of the coefficients produced were generally consistent. Arm 3 produced the largest range of utility values (1 to −0.980). Scale parameter testing suggested that the models did not differ, and the data could be pooled. Follow-up questions did not suggest variation in terms of difficulty.

Conclusions

The results suggest that the level of randomisation used in DCE health state valuation studies does not significantly impact values, and dimension order may not be as important as other study design issues. The results support past valuation studies that use the standard order of dimensions.

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Acknowledgements

This study was funded by the Australian National Health and Medical Research Council. Authors BM, RN and RV led the development of the study design, led the data collection and analysis, and drafted the first version of the manuscript. Authors JR, JB, EL and PL contributed to the development of the study design, supported the data analysis and interpretation of the results, and provided detailed revisions of earlier versions of the manuscript.

Author information

Authors and Affiliations

  1. University of Technology Sydney, Centre for Health Economics Research and Evaluation, 1-59 Quay St, Haymarket, Sydney, NSW, 2000, Australia

    Brendan Mulhern & Rosalie Viney

  2. School of Public Health, Curtin University, Kent Street, Bentley, Perth, WA, 6102, Australia

    Richard Norman

  3. Office of Health Economics, Southside, 105 Victoria Street, London, SW1E 6QT, UK

    Paula Lorgelly

  4. Centre for Health Economics, Monash University, Building 75, 15 Innovation Walk, Melbourne, VIC, 3800, Australia

    Emily Lancsar

  5. Flinders Health Economics Group, Flinders University Adelaide, Adelaide, SA, 5001, Australia

    Julie Ratcliffe

  6. Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent St, Sheffield, S1 4DA, UK

    John Brazier

Authors
  1. Brendan Mulhern
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  2. Richard Norman
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  3. Paula Lorgelly
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  4. Emily Lancsar
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  5. Julie Ratcliffe
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  6. John Brazier
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  7. Rosalie Viney
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Corresponding author

Correspondence to Brendan Mulhern.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee [University of Technology Sydney Human Research Ethics Committee (Program Approval Number 2015000135)]. The following authors are members of the EuroQol Research Foundation (the copyright holders of EQ-5D-5L): Brendan Mulhern, Richard Norman, John Brazier, and Rosalie Viney. There are no other conflicts of interest.

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Mulhern, B., Norman, R., Lorgelly, P. et al. Is Dimension Order Important when Valuing Health States Using Discrete Choice Experiments Including Duration?. PharmacoEconomics 35, 439–451 (2017). https://doi.org/10.1007/s40273-016-0475-z

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  • DOI: https://doi.org/10.1007/s40273-016-0475-z

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