The moral relevance of personal characteristics in setting health care priorities

Title: The moral relevance of personal characteristics in setting health care priorities
Authors: Olsen, Jan Abel and Richardson, Jeff and Dolan, Paul and Menzel, Paul
Publisher: Social science & medicine, 57 (7). pp. 1163-1172
ISSN: 0277-9536
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Abstract: This paper discusses the moral relevance of accounting for various personal characteristics when prioritizing between groups of patients. After a review of the results from empirical studies, we discuss the ethical reasons which might explain–and justify–the views expressed in these studies. The paper develops a general framework based upon the causes of ill health and the consequences of treatment. It then turns to the question of the extent to which a personal characteristic–and the eventual underlying ethical justification of its relevance–could have any relationships to these causes and consequences. We attempt to disentangle those characteristics that may reflect a potentially relevant justification from those which violate widely accepted principles of social justice.

A single European currency for EQ-5D health states.

Title: A single European currency for EQ-5D health states.
Authors: Greiner, Wolfgang and Weijnen, Tom and Nieuwenhuizen, Martin and Oppe, Siem and Badia, Xavier and Busschbach, Jan and Buxton, Martin and Dolan, Paul and Kind, Paul and Krabbe, Paul and Ohinmaa, Arto and Parkin, David and Roset, Montserat and Sintonen, Harri and Tsuchiya , Aki and de Charro, Frank
Publisher: The European journal of health economics, 4 (3). pp. 222-231
ISSN: 1618-7598
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Abstract: The EQ-5D questionnaire is a widely used generic instrument for describing and valuing health that was developed by the EuroQol Group. A primary objective of the EuroQol Group is the investigation of values for health states in the general population in different countries. As part of the EuroQol enterprise 11 population surveys were carried out in six Western European countries (Finland, Germany, The Netherlands, Spain, Sweden and the UK) to value health states as defined by the EQ-5D using a standardised visual analogue scale (EQ-5D VAS).This contribution reports how a European set of general population preference weights was derived from the data collected in the 11 valuation studies. The scores from this set of preference weights can be applied to generate a VAS-based weighted health status index for all the potential 243 EQ-5D health states for use in multi-national studies. To estimate the preference weights a multi-level regression analysis was performed on 82,910 valuations of 44 EQ-5D health states elicited from 6,870 respondents. Stable and plausible solutions were found for the model parameters.TheR2 value was 75%.The analysis showed that the major source of variance, apart from ‘random error’, was variance between individuals (28.3% of the total residual variance). These results suggest that VAS values for EQ-5D health states in six Western European countries can be described by a common model.

The validity of time trade-off values in calculating QALYs: constant proportional time trade-off versus the proportional heuristic

Title: The validity of time trade-off values in calculating QALYs: constant proportional time trade-off versus the proportional heuristic
Authors: Dolan, Paul and Stalmeier, Peep
Publisher: Journal of health economics, 22 (3). pp. 445-458
ISSN: 0167-6296
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Abstract: In order to calculate quality adjusted life years (QALYs) from time trade-off (TTO) responses, individual preferences are required to satisfy the constant proportional time trade-off (CPTTO) assumption. Respondents who use a simple proportional heuristic may appear to satisfy CPTTO but will in fact generate preference reversals for states that are associated with a maximal endurable time (MET). Using data from 91 respondents, the study reported here examines the extent to which valuations satisfy the CPTTO assumption and the extent to which they might be generated by the proportional heuristic. The results suggest that respondents are using a proportional heuristic that casts doubt on the validity of using the TTO method to calculate QALYs for health states that are associated with MET preferences.

A note on the relative importance that people attach to different factors when setting priorities in health care

Title: A note on the relative importance that people attach to different factors when setting priorities in health care
Authors: Dolan, Paul and Shaw, Rebecca
Publisher: Health expectations, 6 (1). pp. 53-59
ISSN: 1369-6513
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Abstract: Objective To explore whether and to what extent people wish to give differential priority when asked to choose between providing health care treatment for different individuals or groups, on the basis of a range of factors, ranging from health gain to the number of dependants a person has. Design A sample of people resident in York self-completed a questionnaire. Setting The City of York. Participants Twenty-three members of the general public and 29 undergraduate students. Main outcome measures The relative importance of factors that people think should be taken into account when choosing between providing health care treatment for individuals or groups. Results The results suggest that health gain and the consequences for health without treatment are two of the most important considerations. Conclusions A sample of the general public and undergraduate students wish to take account of a number of personal characteristics when setting priorities in health care.

Measuring people’s preferences regarding ageism in health: some methodological issues and some fresh evidence

Title: Measuring people’s preferences regarding ageism in health: some methodological issues and some fresh evidence
Authors: Tsuchiya , Aki and Dolan, Paul and Shaw, R.
Publisher: Social science & medicine, 57 (4). pp. 687-696
ISSN: 0277-9536
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Abstract: In this paper, we outline the three main concepts of ‘ageism’; health maximisation ageism, productivity ageism, and fair innings ageism. We provide a methodological overview of the existing empirical literature on people’s preferences regarding age and classify these studies according to the types of questions that have been asked. We consider some of the methodological issues involved in eliciting preferences regarding ageism and propose using a fixed duration of benefit rather than, as some studies have done, a benefit that lasts for a full lifetime. Informed by this discussion, we present the results from our own empirical study, carried out in the UK, which combines qualitative and quantitative methods to explore the reasons people have for choosing one age over another. In so doing, we are able to consider the extent to which respondents might bring extraneous factors to bear on their responses and/or disregard relevant information (such as that relating to the fixed nature of the benefit). The results suggest that people are broadly in favour of giving priority to younger over older people, based on arguments relating to both productivity ageism and fair innings ageism. However, respondents appear to assume that a benefit would last for a full lifetime (even if they are told to assume a fixed benefit), unless they are asked to consider a ‘full-life’ benefit first. This particular framing effect has important implications for preference elicitation studies, suggesting that if you want people to answer the question you have in mind, first ask them the question you think they may have in mind.

The person trade-off method and the transitivity principle: an example from preferences over age weighting

Title: The person trade-off method and the transitivity principle: an example from preferences over age weighting
Authors: Dolan, Paul and Tsuchiya , Aki
Publisher: Health economics, 12 (6). pp. 505-510
ISSN: 1057-9230
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Abstract: The person trade-off (PTO) is increasingly being used to elicit preferences in health. This paper explores the measurement properties of the PTO method in the context of a study about how members of the public prioritise between patients of different ages. In particular, it considers whether PTO responses satisfy the transitivity principle; that is, whether one PTO response can be inferred from two other PTO responses. The results suggest that very few responses to PTO questions satisfy cardinal transitivity condition. However, this study has produced results that suggest that cardinal transitivity will hold, on average, when respondents who fail to satisfy the ordinal transitivity condition have been excluded from the analysis. This suggests that future PTO studies should build in checks for ordinal transitivity.