Using a Discrete Choice Experiment to Value the EQ-5D-5L in Canada Nick Bansback Assistant Professor School of Population and Public Health, University.

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Using a Discrete Choice Experiment to Value the EQ-5D-5L in Canada Nick Bansback Assistant Professor School of Population and Public Health, University of British Columbia CIHR New Investigator

Conflict of interest Member of the EuroQol group No conflicts related to this presentation

National Health State Valuation Studies We want: An algorithm for a descriptive health classification system That reflect values from individuals that engage and understand the task From a representative sample of general population

How many people engage and understand the TTO? We excluded 136 (11%) from the TTO analysis: Illogical responses (e.g. value some pain better than no pain) Implausible responses (e.g. value mild health states as worse than dead) Untrustworthy responses (e.g. value a variety of health states the same)

How many people engage and understand the TTO? Engel L. et al. Exclusion Criteria in National Health State Valuation Studies: a Systematic Review

But did the rest really understand and engage? Values for health state NN Values for all health states

Impact of exclusions on representativeness In the wider literature, excluded persons tend to be older, less educated and sicker 1 Similar findings in our TTO study Impact of exclusions on values varies between studies 1 Small differences (larger at more severe health states) found in our TTO study → the TTO task seems to lead to exclusions that might influence the representativeness and numbers in National Health State Valuation Studies 1. Engel L. et al. Exclusion Criteria in National Health State Valuation Studies: a Systematic Review

Discrete choice experiment with a duration attribute (DCEtto) Health State AHealth State B Some problems in walking about No problems in walking about No problems with self-careSome problems with self-care Some problems with performing my usual activities Moderate pain or discomfortNo pain or discomfort Not anxious or depressedExtremely anxious or depressed Live for 10 yearsLive for 7 years Choose A or B Health State AHealth State B Some problems in walking about No problems in walking about No problems with self-care Some problems with performing my usual activities No problems with performing my usual activities Moderate pain or discomfortNo pain or discomfort Not anxious or depressed Live for 10 years Live for t years Vary t until indifferent between A and B DCEtto Requires if health state A is preferred to B and not the degree by which A is preferred to B TTODCEtto

Previous research in DCEtto Simpler (fewer drop-outs) Enables incorporation of all respondents, increasing power and representativeness Cognition Included with no change in task or arbitrary transformation States worse than dead DCEs rooted in economic theory (RUT) Theory Quick to complete Can be implemented on the web (cheaper) Practical Bansback, et al. "Using a discrete choice experiment to estimate health state utility values." Journal of health economics 31.1 (2012): Bansback, et al. "Testing a discrete choice experiment including duration to value health states for large descriptive systems: Addressing design and sampling issues." Social Science & Medicine 114 (2014):

Canadian EQ-5D 5L study Alongside the TTO, participants also completed between 7 and 9 DCEtto tasks (in 7 tasks duration was equal between options) A total of 252 DCE unique pairs were valued – created using D-efficient designs 1107 respondents – observations Modelled using conditional logit model, interacting duration with each level of each EQ- 5D dimension

Differences in distribution of values Values for health state NN Values for all health states

Differences in average values ←Better health states Worse health states→ Utility values

Impact of excluded respondents from TTO ←Better health states Worse health states→ Utility values

Limitations Unclear whether the DCEtto really is simpler Harder to test whether respondents have engaged and understood the task Gives lower values than TTO – but these are not directly valued - difficult to know if they are real …All questions currently being investigated in studies by our team and others