Analog scale, magnitude estimation, and person trade-off as measures of health utility: biases and their correction

Abstract

Subjects judged the disutility of health conditions "e[g[ blindness# using one of them "e[g[ blindness¦deafness# as a standard\ using three elicitation methods] analog scale "AS\ how bad is blindness compared to blindness¦deafness<#^mag! nitude estimation "ME\ blindness¦deafness is how many times as bad as blind! ness<#^and person trade!o} "PTO\ how many people cured of blindness is as good as 09 people cured of blindness¦deafness<#[ ME disutilities of the less bad condition were smallest\ and AS was highest[ Interleaving PTO with ME made PTO more like ME[ AS disutilities were inconsistent with direct judgments of di}erences between pairs of conditions[ ME and PTO judgments were internally inconsistent] e[g[ the disutility of one!eye!blindness relative to blindness¦deafness was larger than predicted from comparison of each to blindness[ Consistency training reduced inconsistency\ increased agreement between AS and PTO\ and transferred from one method to the other[ The results support the use of con! sistency checks in utility elicitation[

The lack of theoretical support for using person trade-offs in QALY-type models

“…In a similar spirit, the World Health Organization has in some instances used a Disability-Adjusted Life Years (DALY) model with disability weights estimated by person trade-off protocols for assessment of region-and disease-specific burden of disease [50]. 1 Despite the popularity of health indices based on person trade-offs and many conceptual (non-technical) or experimental studies of the pros and cons of using such person trade-off based indices, theoretical support for its use has not been investigated ( [6,11,13,17]). In contrast, Williams [49] argues that the person trade-off method, as employed in the DALY valuations, muddles the valuation of the health states with people's views about distributional issues.…”

“…Certainly, not all literature concerned with person tradeoffs has suggested this specific application of person tradeoffs, and the present criticism does of course not concern the literature where QALY or DALY models play only a minor role (if any), e.g., Patrick et al [32], Olsen [31], Ubel et al [42,43,46], Pinto Prades [33], Pinto Prades and Lopez-Nicolás [35], Baron et al [1], Green [11], Rodrí-guez-Míguez and Pinto Prades [37], Dolan and Tsuchiya [10].…”

Revising a Priority List Based on Cost-Effectiveness

“…In particular, the usual methods of utility assessment may overstate the disutility of mild or moderate health conditions or, equivalently, overstate the benefit of curing or preventing such conditions. 9 For example, Ubel and others 4 asked subjects, "You have a ganglion cyst on one hand. This cyst is a tiny bulge on top of one of the tendons in your hand.…”

“…Previous research suggests that such distortion occurs and can be corrected somewhat by asking subjects to think about the relation of what they are judging to the midpoint of the scale. 9 Both our hypotheses are about psychological factors that affect the evaluation of priority lists derived from utility judgments. One factor, the prominence effect, affects the response to the list, and the other factor involves distortion of the initial utility judgments that are used to produce the list.…”

Improving one’s choices by putting oneself in others’ shoes – An experimental analysis

“…Also see Hansson (1988) and Rabin (2000). 2 See Viscusi (1995 p. 108), Baron et al (2001), Bleichrodt et al (2001), Sunstein (2003, 2008: nudge), Loewenstein and Ubel (2008 §1.2), and Infante et al (2016). For references to early work, see Fischhoff (1982) and Arkes (1991).…”