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Understanding health state valuations: A qualitative analysis of respondents' comments

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Abstract

Self-completed questionnaires (usually distributed by post) and visual analogue scales (VAS) are common means for collecting valuations for hypothetical EQ-5D health states. Although opportunities for respondents to comment on aspects of the exercise are often included, these data have rarely been the focus of analyses. This paper, therefore, reports on solicited and unsolicited written comments received in a New Zealand survey in 1999 to which 1360 people responded of whom approximately 50% made comments. The comments were systematically analysed via an inductive process that allowed principal themes to emerge with respect to understanding the peculiarities of respondents' valuations, particularly common ‘data problems’, and their perceptions as to the adequacy or otherwise of the EQ-5D classification system. From our findings we conclude that the valuation exercise imposes a substantial cognitive burden on respondents and many do not understand it (for a variety of reasons documented in the paper). Also, although there is some evidence for expanding the EQ-5D (generic)health-related quality of life dimensions, more research as to whether this holds for a larger sample and across cultural settings is needed. We offer recommendations for future research into understanding respondents' cognitive processes and possible revisions to the design and administration of the EQ-5D.

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References

  1. Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB, for the Panel on Cost-Effectiveness in Health and Medicine. Recommendations of the Panel on Cost-Effectiveness in Health and Medicine. JAMA 1996;276: 1253–1258.

    PubMed  Google Scholar 

  2. Johnson J, Pickard A. Comparison of the EQ-5D and SF-12 health surveys in a general population survey in Alberta, Canada, Med Care 2000; 38: 115–121.

    Google Scholar 

  3. Wittrup-Jensen KV, Lauridson JT, Gudex C, Brooks R, Pederson KM. Estimating Danish EuroQol tariffs using the time trade-off (TTO) and visual analogue scale (VAS) methods. In: Norinder AL, Pedersen KL, Roos P (eds), Proceedings of the 18th Plenary Meeting of the EuroQol Group, Copenhagen, Denmark.

  4. Ohinmaa A, Eija H, Sintonen H. Modelling EuroQol values of Finnish adult population. In: Badia X, Herdman M, Segura A (eds), EuroQol Plenary Meeting 1995 Discussion Papers, Institut Universitari de Salut Publica de Catalunya, Barcelona: 1995: 67–76.

    Google Scholar 

  5. Claes C, Greiner W, Uber A, J-M Graf v.d. Schulenburg. An interview-based comparison of the TTO and VAS values given to EuroQol states of health by the general German population. In: Greiner W, Graf v.d. Schulenburg J-M, Piercy J (eds), EuroQol Plenary Meeting 1998 Discussion Papers, 1999; 13–39.

  6. Essink-Bot ML, Stouthard M, Bonsel G. Generalizability of valuations on health states collected with the EuroQol questionnaire. Health Econ 1993; 2: 237–246.

    PubMed  Google Scholar 

  7. Devlin N, Hansen P, Kind P, Williams A. Logical inconsistencies: A methodological challenge for the estimation of social tariffs of valuations. Health Econ. 2003; 12: 529–544.

    Article  PubMed  Google Scholar 

  8. Prevolnik Rupel V, Rebolj M. The Slovenian VAS tariff based on valuations of EQ-5D health states from the general population. In: Cabasés JM, Gaminde I (eds), 17th Plenary Meeting of the EuroQol Group Discussion Papers, Pamplona, Spain, 2000.

  9. Gaminde I, Cabasés JM. Measuring valuations for health states amongst the general population in Navarra (Spain). In: Badia X, Herdman M, Segura A (eds), EuroQol Plenary Meeting 1995 Discussion Papers, Institut Universitari de Salut Publica de Catalunya, Barcelona: 1996; 113–122.

  10. Bjork S., Norinder A. The weighting exercise for the Swedish version of the EuroQol. Health Econ. 1999; 8: 117–126.

    Article  PubMed  Google Scholar 

  11. Dolan P, Kind P. Inconsistency and health state valuations. Soc Sci Med 1996; 42: 609–615.

    Article  PubMed  Google Scholar 

  12. Macran S, Kind P. EQ-5D Valuations from a British national Postal survey. In: Cabasés JM, Gaminde I (eds), 17th Plenary Meeting of the EuroQol Group Discussion Papers, Pamplona, Spain, 2000.

  13. Johnson JA, Coons SJ, Ergo A, Szava-Kovats G. Valuation of EuroQol (EQ-5D) health state in an adult US sample. Pharmacoeconomics 1998; 13: 421–433.

    PubMed  Google Scholar 

  14. Badia X, Monserrat S, Roset M, Herdman M. Feasibility, validity and test-retest reliability of scaling methods for health states: The visual analogue scale and the time tradeoff. Qual Life Res 1999; 8: 303–310.

    Article  PubMed  Google Scholar 

  15. Gudex C, Dolan P. Valuing health states: The effect of duration. Discussion Paper 143, Centre for Health Economics, University of York, 1995.

  16. Drummond MF, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health care Programmes. Oxford: Oxford Medical Publications, 1990.

    Google Scholar 

  17. Streiner DL, Norman GR.Health Measurement Scales: A Practical Guide to their Development and Use. Oxford: Oxford University Press, 1995.

    Google Scholar 

  18. Torrance GW, Feeny D, Furlong W. Visual Analogue Scales: Do they have a role in the measurement of preferences for health state. Med Dec Making 2001; 21(4) 329–334.

    Article  Google Scholar 

  19. Dolan P, Gudex C, Kind P, Williams A. The Measurement and Valuation of Health. First Report on the Main Survey. The MVH Group. University of York: Centre for Health Economics, 1994.

    Google Scholar 

  20. Selai C. The problem of logical inconsistency in elicited EuroQol values: Discussion Paper. In: Badia X, Herdman M, Roset M (eds), Proceedings from the 16th Plenary Meeting of the EuroQol Group, Sitges, Spain, 6-9 November, 1999. (Proceedings are available from the EQ-5D Business Management on request to rabin@gbr.frg.eur.nl).

  21. Coons S, Johnson J. Comparison of the EQ-5D and SF-12 in an adult US-based population sample. In: Nord E (ed), Conference Proceedings: EuroQol Plenary Meeting Oslo, 17-18 October 1996, Oslo: National Institute of Public Health, 1997.

  22. Barofsky I. Cognitive aspects of quality of life assessment. In: Spilker B (ed), Quality of Life and Pharmacoeconomics in Clinical Trials, Philadelphia: Lippincott-Raven, 1996.

    Google Scholar 

  23. Robinson A, Dolan P, Williams A. Valuing health status using VAS and TTO: What lies behind the numbers? Soc Sci Med 1997; 45: 1289–1297.

    Article  PubMed  Google Scholar 

  24. Lezak M. Neuropsychological Assessment. Oxford: Oxford University Press, 1995.

    Google Scholar 

  25. Miller GA. The magical number seven, plus or minus two: Some limits on our capacity for processing information. Psycholo Rev 1956; 63: 81–97.

    Google Scholar 

  26. Dolan P. The measurement of health-related quality of life. In: Culyer A, Newhouse J (eds), Handbook of Health Economics, Vol. 1b, Amsterdam: North Holland, 2000, Chapter 32.

    Google Scholar 

  27. Pope C, Ziebland S, Mays N. Analysing qualitative data. Br Med J 2000; 320: 114–116.

    Google Scholar 

  28. Patton M. Enhancing the quality and credibility of qualitative analysis. Health Serv Res 1999; 24: 1189–1208.

    Google Scholar 

  29. NUD*IST ('Non-numerical Unstructured Data with powerful processes of Indexing Searching and Theorizing'), Quality Systems Registrars (QSR), Inc. Available from http://www.qsr.com.au/products/n5.html.

  30. Bryman A. Social Research Methods. Oxford University Press, 2001.

  31. Tourangeau R, Rips LJ, Rasinski K. The Psychology of Survey Response. Cambridge University Press, 2000.

  32. Brooks R, for the EuroQol Group. EuroQol: The current state of play. Health Policy 1996; 37: 53–72.

    Article  Google Scholar 

  33. Available from http://www.who.int/gb/EB_WHA/PDF/ WHA52/ew24.pdf

  34. Devlin N, Hansen P, Herbison P. Variations in self-reported health status: Results from a New Zealand survey, New Zealand Med J 2000; 113; 1123: 517–520.

    Google Scholar 

  35. Ohinmaa A, Sintonen H. Inconsistencies and modelling of the Finnish EuroQol (EQ-5D) preference values. In: Greiner W, Graf v.d. Schulenburg J-M, Piercy J (eds), EuroQol Plenary Meeting, 1998 Discussion papers.

  36. Kennedy PE. Sinning in the basement: What are the rules? The ten commandments of applied econometrics. J Econ Surv, 2001; 16: 569–589.

    Article  Google Scholar 

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Devlin, N.J., Hansen, P. & Selai, C. Understanding health state valuations: A qualitative analysis of respondents' comments. Qual Life Res 13, 1265–1277 (2004). https://doi.org/10.1023/B:QURE.0000037495.00959.9b

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  • DOI: https://doi.org/10.1023/B:QURE.0000037495.00959.9b

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