Is the Person Trade-off a Valid Method for Allocating Health Care Resources?

Abstract

The Person Trade-Off (PTO) is a methodology aimed at measuring the social value of health states. It is claimed that other methods measure individual utility and are less appropriate for taking resource allocation decisions. However, few studies have been conducted to test the apparent superiority of the method for this particular kind of decision. We present a pilot study to this end. The study is based on the results of interviewing 30 undergraduate students in economics. We compare two well known techniques, the Standard Gamble and the Visual Analogue Scale, with the PTO. The criterion against which the performance of the methods is assessed is the directly obtained preference about how to establish priorities among hypothetical patients waiting for treatment. Apparently the PTO performed better than the others. We also compare three different frames for the PTO. One of them seems to predict people's preferences.

Trading people versus trading time: What is the difference?

“…Most previous studies comparing the PTO method to other traditional preference measures framed choices in terms of curing a less severe chronic condition than ones described in our study, versus saving the lives of previously healthy patients. In nearly all cases, contrary to our results, indifference points were higher when obtained through a PTO elicitation compared to those computed from a traditional utility elicitation method; this was true for the rating scale [ 18 ], visual analog scale [ 17 ], TTO [ 14 , 19 , 25 ], and standard gamble [ 14 , 17 ]. One reason for the lack of differentiation in our study may be because of the way we framed the PTO scenario.…”

Lack of multiplicative transitivity in person trade‐off responses

“…Our study showed significant inconsistency in PTO responses unlike the study by Pinto Prades in the case of health states described with EuroQol only [23]. This study included 30 health economics students in face-to-face interviews valuing four health states described by a health-related quality of life instrument only, i.e.…”

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

“…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].…”