1. 1 Are values cultural determined…..  Many believe that QoL is cultural determined  One of the starting points of the EuroQol group

2. 2 First international comparisons in 1988 with EQ-6D and VAS

3. 3 Does TTO differs in Western Europe ?

4. 4 Replication TTO in the UK

5. 5 Do European values differs to the rest of the world ?

6. 6 Does VAS differs across nations?

7. 7 Positive TTO values differ little

8. 8 Negative TTO values seem to matter

9. 9 New evidence  UK  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?

10. 10 Conclusions  Patient values include coping  High values  Cultural differences exists  Especially in (negative) TTO values  Not yet clear what the consequences are Or should be…

11. 11 Little difference between Cost/Life Year and Cost/QALY Richard Chapman et al, 2004, Health Economics

12. 12 Difference in QALYs makes little difference in outcome  Richard Chapman et al, 2004  “In a sizable fraction of cost-utility analyses, quality adjusting did not substantially alter the estimated cost-effectiveness of an intervention, suggesting that sensitivity analyses using ad hoc adjustments or 'off-the-shelf' utility weights may be sufficient for many analyses.”  “The collection of preference weight data should […] should only be under-taken if the value of this information is likely to be greater than the cost of obtaining it.”

13. 13 QALYs make a difference when:  Chronic disease  Palliative  Long term negative consequences

14. 14 Person Trade-Off  Values between patients  Not ‘within’ a patient like SG, TTO and VAS  Better equipped for QALY?  V(Q) = 1 - (A / B)  For instance:  V(Q) = 1 - (100/300)  V(Q) = 1 - 0.33  V(Q) = 0.67 ?? persons 1 year free from disease Q 100 persons additionally 1 healthy year

15. 15 PTO gives extreme low values

16. 16 PTO and it’s psychometrics  Paul Kind:  If we look at TTO and PTO...  we see that one of them is wrong  If we look at PTO alone...  We still see that one of them is wrong... PTO is not a quick fix