Are values cultural determined….. Many believe that QoL is cultural determined One of the starting points of the EuroQol group

First international comparisons in 1988 with EQ-6D and VAS

Does TTO differs in Western Europe ?

Replication TTO in the UK

Do European values differs to the rest of the world ?

Does VAS differs across nations?

Positive TTO values differ little

Negative TTO values seem to matter

New evidence UK US Publication bias Scottish population is tougher Only publish in main report US Black, Hispanic differ Yet to be published Publication bias Difficulty disentangle Test retest reliability Cultural effect What should be the consequence of cultural difference?

Conclusions Patient values include coping Cultural differences exists High values Cultural differences exists Especially in (negative) TTO values Not yet clear what the consequences are Or should be…