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Sequence Effects, Health Profiles, and the QALY Model

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  • Paul F. M. Krabbe
  • Gouke J. Bonsel

Abstract

The authors conducted an experiment to determine whether the sequence of presentation of states in a health profile would affect the valuations assigned to them. The empirical task was part of a large standardized experiment involving 104 students. Thirteen health states were valued using two variations of the time-tradeoff method. At the group level, a small but distinct overall effect of the sequence of the tradeoffs was detected after accounting for discounting effects. The respondents were not preference-indifferent concerning the sequence of health states presented. Detailed analysis at the individual level indicated that the overall sequence effect was attributable to two groups of respondents who were sensitive to the sequence of events. One small group, referred to as “best-things-first†respondents, preferred the best years first; the other group, classified as “happy-end†respondents, preferred the reverse sequence. The majority of the respondents, however, were indifferent to the sequence. These results suggest that 1) in valuation experiments involving the time-tradeoff method and 2) in applying valuation results to the evaluation of real-life health consequences, a varying lifetime health profile may not be regarded as simply a chain of independent separately valued and discounted QALY periods. Even elementary valuation tasks cannot safely assume ignorance of prognosis, as the additive utility independence assumption of the QALY model does not hold. The sequence effect at least supplements the conventional general time-preference concept, and specific strategies are suggested to disentangle quantitatively the sequence effect and the time-preference effect.

Suggested Citation

  • Paul F. M. Krabbe & Gouke J. Bonsel, 1998. "Sequence Effects, Health Profiles, and the QALY Model," Medical Decision Making, , vol. 18(2), pages 178-186.
  • Handle: RePEc:sae:medema:v:18:y:1998:i:2:p:178-186
    DOI: 10.1177/0272989X9801800207
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    Citations

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    Cited by:

    1. Luciana Scalone & Peep Stalmeier & Silvano Milani & Paul Krabbe, 2015. "Values for health states with different life durations," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(9), pages 917-925, December.
    2. Bleichrodt, Han & Filko, Martin, 2008. "New tests of QALYs when health varies over time," Journal of Health Economics, Elsevier, vol. 27(5), pages 1237-1249, September.
    3. Bas Janssen & Mark Oppe & Matthijs Versteegh & Elly Stolk, 2013. "Introducing the composite time trade-off: a test of feasibility and face validity," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 5-13, July.
    4. Carmen Herrero Blanco, 2001. "Individual Evidence Of Independence In Health Profiles Evaluation," Working Papers. Serie AD 2001-20, Instituto Valenciano de Investigaciones Económicas, S.A. (Ivie).
    5. Han Bleichrodt & Jose Luis Pinto, 2012. "Conceptual Foundations for Health Utility Measurement," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 35, Edward Elgar Publishing.
    6. Arthur Attema & Yvette Edelaar-Peeters & Matthijs Versteegh & Elly Stolk, 2013. "Time trade-off: one methodology, different methods," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 53-64, July.
    7. Anne Spencer, 2000. "Testing the Additive Independence Assumption in the QALY Model," Working Papers 427, Queen Mary University of London, School of Economics and Finance.
    8. Guerrero, Ana M. & Herrero, Carmen, 2005. "A semi-separable utility function for health profiles," Journal of Health Economics, Elsevier, vol. 24(1), pages 33-54, January.
    9. McNamee, Paul, 2007. "What difference does it make? The calculation of QALY gains from health profiles using patient and general population values," Health Policy, Elsevier, vol. 84(2-3), pages 321-331, December.
    10. Anne Spencer, 2000. "Testing the Additive Independence Assumption in the QALY Model," Working Papers 427, Queen Mary University of London, School of Economics and Finance.
    11. Peter P. Wakker & Sylvia J. T. Jansen & Anne M. Stiggelbout, 2004. "Anchor Levels as a New Tool for the Theory and Measurement of Multiattribute Utility," Decision Analysis, INFORMS, vol. 1(4), pages 217-234, December.
    12. Kristian Schultz Hansen & Lars Peter Østerdal, 2006. "Models of Quality‐Adjusted Life Years when Health Varies Over Time: Survey and Analysis," Journal of Economic Surveys, Wiley Blackwell, vol. 20(2), pages 229-255, April.

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