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Does the EQ-5D Reflect Lost Earnings?

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Abstract

Background

An important methodological issue in economic evaluations of healthcare is how to include productivity costs (the costs related to reduced productivity due to illness, disability and premature death). Traditionally, they were included in the numerator of a cost-effectiveness analysis, through either the human-capital or the friction-cost method. It has been argued, however, that productivity costs are already included in the denominator (i.e. in the QALY measure) because respondents consider the effect a given health state will have on their income when valuing health states. If that is the case, many previous economic evaluations might have double counted productivity costs by including them in both the numerator and the denominator.

Aim

The aim of this study was to determine whether respondents valuing EQ-5D health states using the time trade-off (TTO) method spontaneously consider income effects, whether this consideration influences subsequent valuations and whether explicit ex post instructions influence valuations.

Methods

Through an online survey, we asked 321 members of the Dutch general population to value four EQ-5D health states through three different TTO exercises. The first exercise was a standard TTO question. Respondents were then asked whether they had included income effects. Depending on their answer, the second TTO exercise instructed them to either include or exclude income effects. The third TTO exercise provided explicit information regarding the income loss associated with the health state.

Results

Data were available from 321 members of the Dutch general public. Of these respondents, 49% stated they had spontaneously included income effects. Twenty-five percent of the sample did not trade any time in any of the TTO exercises and these respondents were excluded from the analysis. Results of t-tests showed there were only weakly significant differences in valuations for one health state between those who spontaneously included income effects and those who did not. Explicit instruction led to some significant differences at the aggregate level, but the effect was inconsistent at the individual level. When explicit information on the amount of income loss was provided, all states were valued lower when associated with a larger income loss.

Conclusions

This study offers further evidence indicating that income losses do not significantly affect health state valuations.

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Notes

  1. 1 The EQ-5D descriptive system has five dimensions and three levels per dimension, giving a total of 243 health states. For example, 22322 describes the following state: some problems with walking about, some problems with washing and dressing, unable to perform usual activities, some pain or discomfort and moderate anxiety and depression.

  2. 2 The TTO method typically asks respondents to make a choice between living in a less-than-perfect state of health for 10 years and living in full health but for a shorter period of time. Commonly, a point of indifference is obtained through an iterative process. If an individual were indifferent between living for 10 years in poor health and for 6 years in full heath, the QALY adjustment for that health state would be 6/10 = 0.6.

References

  1. National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal (N1618). London: NICE, 2008 [online]. Available from URL: http://www.nice.org.uk/media/B52/A7/TAMethodsGuideUpdatedJune2008.pdf [Accessed 2008 Nov 1]

  2. College voor Zorgverzekeringen. Dutch guidelines for pharmacoeconomic research [report ref. CURE/cuo.228/2]. Amstelveen: CVZ, 1999 [online]. Available from URL: www.ispor.org/PEguidelines/source/PE_guidelines_english_Netherlands.pdf [Accessed 2008 Nov 1]

  3. Dolan P. Modelling valuations for EuroQol health states. Med Care 1997; 35 (11): 1095–108

    Article  PubMed  CAS  Google Scholar 

  4. Lamers LM, McDonnell J, Stalmeier PFM, et al. The Dutch tariff: results and arguments for an effective design for national EQ-5D valuations studies. Health Econ 2006; 15 (10): 1121–32

    Article  PubMed  CAS  Google Scholar 

  5. Shaw JW, Johnson JA, Coons SJ. US valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med Care 2005; 43 (3): 203–20

    Article  PubMed  Google Scholar 

  6. Greiner W, Claes C, Buschbach JJV, et al. Validating the EQ-5D with time trade off for the German population. Eur J Health Econ 2005; 6 (2): 124–30

    Article  PubMed  CAS  Google Scholar 

  7. Brouwer WBF, Koopmanschap MA, Rutten FHH, et al. Productivity costs measurement through quality of life? A response to the recommendation of the Washington Panel. Health Econ 1997; 6: 253–9

    Article  PubMed  CAS  Google Scholar 

  8. Gold MR, Siegel JE, Russell LB, et al. Cost-effectiveness in health and medicine. Oxford: Oxford University Press, 1996

    Google Scholar 

  9. Tilling CJ, Krol M, Tsuchiya A, et al. In or out? Income losses in health state valuations: a review. Value Health. 2010; 13 (2): 298–305

    Article  PubMed  Google Scholar 

  10. Weisbrod BA. The valuation of human capital. J Polit Econ 1961; 69 (5): 425–36

    Article  Google Scholar 

  11. Rice D, Cooper B. The economic value of human life. Am J Public Health 1967; 57: 1954–66

    Article  CAS  Google Scholar 

  12. Koopmanschap MA, van Ineveld B. Towards a new approach for estimating indirect costs of disease. Soc Sci Med 1992; 34: 1005–10

    Article  PubMed  CAS  Google Scholar 

  13. Krol M, Brouwer WBF, Sendi P. Productivity costs in health-state valuations: does explicit instruction matter?. Pharmacoeconomics 2006; 24 (4): 401–14

    Article  PubMed  Google Scholar 

  14. Davidson T, Levin LA. Do individuals consider expected income when valuing health states?. Int J Technol Assess Health Care 2008; 24 (4): 488–94

    Article  PubMed  Google Scholar 

  15. Brouwer WBF, Grootenboer S, Sendi P. The incorporation of income and leisure in health state valuations when the measure is silent: an empirical inquiry into the sound of silence. Med Decis Making 2009; 29 (4): 503–12

    Article  PubMed  Google Scholar 

  16. Krol M, Sendi P, Brouwer WBF. Breaking the silence: exploring the potential effects of explicit instructions on incorporating income and leisure in TTO exercises. Value Health 2009; 12 (10): 172–80

    Article  PubMed  Google Scholar 

  17. Meltzer D, Weckerle CE, Chang LM. Do people consider financial effects in answering quality of life questions? [abstract]. Med Decis Making 1999; 19: 517

    Article  Google Scholar 

  18. Sendi P, Brouwer WBF. Is silence golden? A test of the incorporation of the effects of ill-health on income and leisure in health state valuations. Health Econ 2005; 14: 643–7

    Article  PubMed  Google Scholar 

  19. Myers J, McCabe S, Gohmann S. Quality-of-life assessment when there is a loss of income. Med Decis Making 2007; 27: 27–33

    Article  PubMed  Google Scholar 

  20. Richardson J, Peacock S, Lezzi A. Do quality-adjusted life years take account of lost income? Evidence from an Australian survey. Eur J Health Econ 2009; 10 (1): 103–9

    Article  PubMed  Google Scholar 

  21. Tsuchiya A, Ikeda S, Ikegami N, et al. Estimating an EQ-5D population value set: the case of Japan. Health Econ 2002; 11 (4): 341–53

    Article  PubMed  Google Scholar 

  22. Attema AE, Brouwer WBF. The correction for utility scores for utility curvature using a risk free utility elicitation method. J Health Econ 2009; 28 (1): 234–43

    Article  PubMed  Google Scholar 

  23. Stata [computer program]. Version 9. College Station (TX): StataCorp, 2005

  24. van Nooten FE, Koolman X, Brouwer WBF. The influence of subjective life expectancy on health state valuations using a 10 year TTO. Health Econ; 2009; 18 (5): 549–58

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Lisa Gold, who discussed a version of this paper at the Health Economists’ Study Group meeting in Manchester in January 2009. They would also like to thank Allan Wailoo, who refereed a version of this paper for inclusion in the Health Economics and Decision Science discussion paper series. Finally, they would like to thank the respondents who took part in this study.

At the time the research was conducted, Carl Tilling was a PhD student funded by the Economic and Social Research Council. No other funding was used for the conduct of this study or preparation of this article.

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Tilling, C., Kro, M., Tsuchiya, A. et al. Does the EQ-5D Reflect Lost Earnings?. PharmacoEconomics 30, 47–61 (2012). https://doi.org/10.2165/11539910-000000000-00000

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