Objectives: To compare rank, visual analog scale and time trade-off valuation techniques for EQ-5D states in eight countries Research Design: We compared rank, visual analog scale, and time trade-off responses for 52 states using Spearman's correlation and Kendall's tau and data from eight countries (Slovenia, Argentina, Denmark, Japan, Netherlands, Spain, United Kingdom, and United States). For each country, rank-based health state values were estimated using conditional logit models and normalize the estimates so that dead has a value of 0, and the state with no problems on any dimension has a value of 1. To further demonstrate the relationship between valuation techniques, we compared rank-based estimates with time tradeoff and visual analog scale estimates using Pearson's rho, Lin's rho, and quadratic regression. Results: For each country, rank responses differ from time trade-off responses: they are less likely to be tied and less likely to be characterized as worse than Immediate Death on direct rankings. Rank-based estimates of health state values show a strong linear correlation with both time trade-off estimates (Pearson's rho = 0.88 to 0.99) and visual analog scale estimates (rho = 0.91 to 0.98). However, modeled rank-based values with the simple rescaling described here imply greater decrements in health for mild states than values based on visual analog scale, and time trade-off in all countries. Conclusions: Illiteracy and innumeracy can hinder efforts to measure societal preferences over health states, particularly in the developing world. In settings of relatively low educational attainment, common valuation instruments, such as time trade-off, may not be feasible. Simple health state ranking techniques may succeed under these circumstances and capture preferences from less numerate respondents. In this paper, we find a strong correlation between rankings and more complex valuation techniques for eight countries. These results suggest that ranking exercises may provide an attractive alternative to time trade-off for deducing values of health states for use in economic modeling.
Despite the increasing use of panel surveys, little is known about the differences in data quality across panels.The aim of this study was to characterize panel survey companies and their respondents based on (1) the timeliness of response by panelists, (2) the reliability of the demographic information they self-report, and (3) the generalizability of the characteristics of panelists to the US general population. A secondary objective was to highlight several issues to consider when selecting a panel vendor.We recruited a sample of US adults from 7 panel vendors using identical quotas and online surveys. All vendors met prespecified inclusion criteria. Panels were compared on the basis of how long the respondents took to complete the survey from time of initial invitation. To validate respondent identity, this study examined the proportion of consented respondents who failed to meet the technical criteria, failed to complete the screener questions, and provided discordant responses. Finally, characteristics of the respondents were compared to US census data and to the characteristics of other panels.Across the 7 panel vendors, 2% to 9% of panelists responded within 2 days of invitation; however, approximately 20% of the respondents failed the screener, largely because of the discordance between self-reported birth date and the birth date in panel entry data. Although geographic characteristics largely agreed with US Census estimates, each sample underrepresented adults who did not graduate from high school and/or had annual incomes less than US $15,000. Except for 1 vendor, panel vendor samples overlapped one another by approximately 20% (ie, 1 in 5 respondents participated through 2 or more panel vendors).The results of this head-to-head comparison provide potential benchmarks in panel quality. The issues to consider when selecting panel vendors include responsiveness, failure to maintain sociodemographic diversity and validated data, and potential overlap between panels.
Out-of-pocket expenditures of over 34 billion dollars per year in the US are an apparent testament to a widely held belief that complementary and alternative medicine (CAM) therapies have benefits that outweigh their costs. However, regardless of public opinion, there is often little more than anecdotal evidence on the health and economic implications of CAM therapies. The objectives of this study are to present an overview of economic evaluation and to expand upon a previous review to examine the current scope and quality of CAM economic evaluations.The data sources used were Medline, AMED, Alt-HealthWatch, and the Complementary and Alternative Medicine Citation Index; January 1999 to October 2004. Papers that reported original data on specific CAM therapies from any form of standard economic analysis were included. Full economic evaluations were subjected to two types of quality review. The first was a 35-item checklist for reporting quality, and the second was a set of four criteria for study quality (randomization, prospective collection of economic data, comparison to usual care, and no blinding).A total of 56 economic evaluations (39 full evaluations) of CAM were found covering a range of therapies applied to a variety of conditions. The reporting quality of the full evaluations was poor for certain items, but was comparable to the quality found by systematic reviews of economic evaluations in conventional medicine. Regarding study quality, 14 (36%) studies were found to meet all four criteria. These exemplary studies indicate CAM therapies that may be considered cost-effective compared to usual care for various conditions: acupuncture for migraine, manual therapy for neck pain, spa therapy for Parkinson's, self-administered stress management for cancer patients undergoing chemotherapy, pre- and post-operative oral nutritional supplementation for lower gastrointestinal tract surgery, biofeedback for patients with "functional" disorders (eg, irritable bowel syndrome), and guided imagery, relaxation therapy, and potassium-rich diet for cardiac patients.Whereas the number and quality of economic evaluations of CAM have increased in recent years and more CAM therapies have been shown to be of good value, the majority of CAM therapies still remain to be evaluated.
Analyses of preference evidence frequently confuse heterogeneity in the effects of attribute parameters (i.e., taste coefficients) and the scale parameter (i.e., variance). Standard latent class models often produce unreasonable classes with high variance and disordered coefficients because of confounding estimates of effect and scale heterogeneity. In this study, we estimated a scale-adjusted latent class model in which scale classes (heteroskedasticity) were identified using respondents’ randomness in choice behavior on the internet panel (e.g., time to completion and time of day). Hence, the model distinctly explained the taste/preference variation among classes associated with individual socioeconomic characters, in which scales are adjusted. Using data from a discrete-choice experiment on US health insurance demand among single employees, the results demonstrated how incorporating behavioral data enhances the interpretation of heterogeneous effects. Once scale heterogeneity was controlled, we found substantial heterogeneity with 4 taste classes. Two of the taste classes were highly premium sensitive (economy class), coming mostly from the low-income group, and the class associated with better educational backgrounds preferred to have a better quality of coverage of health insurance plans. The third class was a highly quality-sensitive class, with a higher SES background and lower self-stated health condition. The last class was identified as stayers, who were not premium or quality sensitive. This case study demonstrates that one size does not fit all in the analysis of preference heterogeneity. The novel use of behavioral data in the latent class analysis is generalizable to a wide range of health preference studies.
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