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Logical inconsistencies in time trade-off valuation of EQ-5D-5L health states: Whose fault is it?

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  • Zhihao Yang
  • Jan van Busschbach
  • Reinier Timman
  • M F Janssen
  • Nan Luo

Abstract

Introduction: Inconsistency in the time trade-off (TTO) task in EQ-5D-5L occurs when a respondent gives a higher value to a logically worse health state, the occurrence of inconsistency compromises the quality of the data. It is not yet clear which factors are associated with individual level inconsistency. Relating inconsistency to the characteristics of the respondent, interviewer, and the interview process could be helpful in understanding the causes of inconsistency. The objective of this paper is to discover the factors associated with individual level inconsistencies. Methods: Twenty interviewers interviewed 1,296 respondents and each respondent valued 10 health states using the EQ-VT platform in 5 cities in China. At the respondent level, inconsistency was identified in terms of severity and quantity and related to the respondent’s background characteristics, the time and iterations spent on the wheelchair example task, and the formal TTO tasks, using multilevel multinomial regression analyses. Interviewers’ impact on inconsistencies was analyzed using single level multinomial regression analyses. Results: In the full dataset, slight inconsistency was more related to the interview process (Time spent on TTO task: RRR = 1.246 with 95%CI: 1.076,1.441; time spent on Wheelchair example: RRR = 0.815 with 95%CI:0.699,0.952) while severe inconsistency was more related to respondent’s gender (Gender: RRR = 2.347 with 95%CI:1.429,3.855). One Interviewer (Interviewer 7: RRR = 7.335 with 95%CI:1.908,28.195) and interviewer’s experience (Sequence: RRR = 0.511 with 95%CI:0.385,0.678) in general showed strong influence over inconsistency in the TTO task. Conclusion: In conclusion, logical inconsistency in the valuation of EQ-5D-5L health states is associated not only with respondents’ characteristics but also with interviewers’ performance and the interview process. The role of interviewers and the importance of interviewer training may be more crucial than hitherto believed. This finding could be generalizable to other interviewer-administered health-state valuation study.

Suggested Citation

  • Zhihao Yang & Jan van Busschbach & Reinier Timman & M F Janssen & Nan Luo, 2017. "Logical inconsistencies in time trade-off valuation of EQ-5D-5L health states: Whose fault is it?," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-10, September.
    • Handle: RePEc:plo:pone00:0184883
    DOI: 10.1371/journal.pone.0184883
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    References listed on IDEAS

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    1. Leida M. Lamers & Peep F. M. Stalmeier & Paul F. M. Krabbe & Jan J. V. Busschbach, 2006. "Inconsistencies in TTO and VAS Values for EQ-5D Health States," Medical Decision Making, , vol. 26(2), pages 173-181, March.
    2. Badia, Xavier & Roset, Monserrat & Herdman, Michael, 1999. "Inconsistent responses in three preference-elicitation methods for health states," Social Science & Medicine, Elsevier, vol. 49(7), pages 943-950, October.
    3. Nancy J. Devlin & Paul Hansen & Paul Kind & Alan Williams, 2003. "Logical inconsistencies in survey respondents' health state valuations ‐ a methodological challenge for estimating social tariffs," Health Economics, John Wiley & Sons, Ltd., vol. 12(7), pages 529-544, July.
    4. Mark Oppe & Kim Rand-Hendriksen & Koonal Shah & Juan M. Ramos‐Goñi & Nan Luo, 2016. "EuroQol Protocols for Time Trade-Off Valuation of Health Outcomes," PharmacoEconomics, Springer, vol. 34(10), pages 993-1004, October.
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