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Abstract
OBJECTIVES The visual analogue scale (VAS) has been used in the context of health and healthcare for various purposes, for example, to measure pain and to provide a single-index measure of health-related quality of life (HRQoL). This scoping review aims to describe how the VAS has been used for health state valuation in the published literature. METHODS The search was carried out in Medline, Web of Science and PsycInfo. The findings of the included articles were tabulated and presented descriptively using frequencies and proportions. RESULTS The database search yielded 4856 unique articles, out of these, 308 were included. In 83% of the articles, the main purpose for using a VAS was to value health states. The two most common perspectives when valuing health states with a VAS were hypothetical (44%) and own health (34%). Some (n = 14) articles used the VAS in the context of economic evaluations, including calculating quality-adjusted life years (QALYs). A large variation in the design of the VAS was found, including the description of the lower and upper anchors. Advantages and disadvantages with using a VAS were mentioned in 14% of the included articles. CONCLUSION The VAS has been a common method for valuing health states, both as a stand-alone method and in combination with other valuation methods. Despite its widespread use, the design of the VAS has been inconsistent which makes comparison of results across studies challenging. Further research on the role of using the VAS in economic evaluations is warranted.
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Affiliation(s)
- Mimmi Åström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Zin Min Thet Lwin
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Fitsum Sebsibe Teni
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Berg
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
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Attema AE, Brouwer WBF, Pinto‐Prades JL. Reference-dependent age weighting of quality-adjusted life years. Health Econ 2022; 31:2515-2536. [PMID: 36057854 PMCID: PMC9826257 DOI: 10.1002/hec.4593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
People do not only care about maximizing health gains but also about their distribution. For example, they give more weight to younger patients than older patients. This pilot study aims to investigate if age weighting is reinforced by loss aversion if young people are falling behind one's perceived 'normal' quality of life (QoL), while older people do not. We apply a person trade-off method in a large representative sample (n = 990) to estimate age weighting factors. We also measure QoL levels that individuals regard as 'normal' for different ages, serving as reference points. We observe a considerable amount of age weighting, with 20-year-old patients on average receiving 1.7 times as much weight as 80-year-old patients. Perceived 'normal' QoL rapidly decreases with age of a patient. Older people are more optimistic about what constitutes 'normal QoL' than younger people, but they express a faster decline in normal QoL due to aging. Respondents who view all improvements to be gain enlarging show the least age weighting, but loss aversion cannot explain the results. Still, one's age-related reference level is an important predictor of age weights. Given the explorative nature of this study, further studies are called for to generate more robust evidence.
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Affiliation(s)
- Arthur E. Attema
- Erasmus School of Health Policy & Management (ESHPM)Erasmus UniversityRotterdamthe Netherlands
| | - Werner B. F. Brouwer
- Erasmus School of Health Policy & Management (ESHPM)Erasmus UniversityRotterdamthe Netherlands
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Attema AE, Brouwer WBF, Pinto JL. The Role of Perceived Utility of Full Health in Age Weighting. Value Health 2022; 25:1559-1565. [PMID: 35680548 DOI: 10.1016/j.jval.2022.04.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES People often give different weights to quality-adjusted life-years (QALYs) gained by different socioeconomic groups. It is well known that QALY gains of younger patients generally get more weight than the same QALY gains accruing to older patients. This study aims to separate these age-related preferences into "pure age weighting" and age weighting caused by full health not perceived as being the same for the old as for the young. METHODS We apply a person trade-off method in a large sample representative (N = 500) of the Dutch general adult population to estimate age weighting factors. We describe health as a percentage of what is considered full health for a given age, for which we obtain a proxy in a separate task. RESULTS A high amount of age weighting is observed, with QALYs to 20-year-old patients receiving approximately 1.5 times as much weight as QALYs to 80-year-old patients. At the same time, we see that individuals do not perceive full health to be the same for young and older people. In fact, the age weighting disappears once we control for these differences in full health perceptions. CONCLUSIONS Respondents had strong preferences for the young relative to the old, but these preferences were related to full health perceptions, that is, more weight being assigned to younger because full health is at a higher absolute level for them than for the old.
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Affiliation(s)
- Arthur E Attema
- EsCHER, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Werner B F Brouwer
- EsCHER, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jose Luis Pinto
- Department of Economics, Universidad de Navarra, Pamplona, Spain
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Reckers-Droog V, van Exel J, Brouwer W. Willingness to Pay for Health-Related Quality of Life Gains in Relation to Disease Severity and the Age of Patients. Value Health 2021; 24:1182-1192. [PMID: 34372984 DOI: 10.1016/j.jval.2021.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 05/19/2023]
Abstract
OBJECTIVES Decision-making frameworks that draw on economic evaluations increasingly use equity weights to facilitate a more equitable and fair allocation of healthcare resources. These weights can be attached to health gains or reflected in the monetary threshold against which the incremental cost-effectiveness ratios of (new) health technologies are evaluated. Currently applied weights are based on different definitions of disease severity and do not account for age-related preferences in society. However, age has been shown to be an important equity-relevant characteristic. This study examines the willingness to pay (WTP) for health-related quality of life (QOL) gains in relation to the disease severity and age of patients, and the outcome of the disease. METHODS We obtained WTP estimates by applying contingent-valuation tasks in a representative sample of the public in The Netherlands (n = 2023). We applied random-effects generalized least squares regression models to estimate the effect of patients' disease severity and age, size of QOL gains, disease outcome (full recovery/death 1 year after falling ill), and respondent characteristics on the WTP. RESULTS Respondents' WTP was higher for more severely ill and younger patients and for larger-sized QOL gains, but lower for patients who died. However, the relations were nonlinear and context dependent. Respondents with a lower age, who were male, had a higher household income, and a higher QOL stated a higher WTP for QOL gains. CONCLUSIONS Our results suggest that-if the aim is to align resource-allocation decisions in healthcare with societal preferences-currently applied equity weights do not suffice.
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Affiliation(s)
- Vivian Reckers-Droog
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
| | - Job van Exel
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, The Netherlands
| | - Werner Brouwer
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, The Netherlands
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Péntek M, van Exel J, Gulácsi L, Brodszky V, Zrubka Z, Baji P, Rencz F, Brouwer WBF. Acceptable health and ageing: results of a cross-sectional study from Hungary. Health Qual Life Outcomes 2020; 18:346. [PMID: 33081803 PMCID: PMC7574437 DOI: 10.1186/s12955-020-01568-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to investigate the acceptability of imperfect health states in relation to age in Hungary and analyse its determinants. Results are contrasted to age-matched actual population health scores and to findings from a previous study in The Netherlands. METHODS A cross-sectional online survey was performed. The same survey questions were applied as in a previous study in The Netherlands in order to enable inter-country comparisons. The descriptive system of the EQ-5D-3L health status questionnaire was used to assess the acceptability of moderate and severe health problems at ages from 30 to 80 by 10-year age-groups. Descriptive statistics were performed and linear regression analysis was used to investigate the determinants of acceptability. RESULTS Altogether 9281 (female 32.8%) were involved with mean age 36.0 years and EQ-5D-3L index score of 0.852 (SD 0.177). Acceptability of health problems increased with age, differed per health domain and with severity of the problems. Except for 'Self-care', moderate health problems were acceptable by the majority from age 70 and acceptability scores were lower than EQ-5D-3L population norms from that age. The lowest average acceptability age was found in the 'Anxiety/depression' and dimension the highest in the 'Self-care' dimension. Respondents' age, current health, and lifestyle were significant determinants (R2: 0.041-0.130). With a few minor exceptions in some health dimensions, acceptability levels and patterns were strikingly similar to the Dutch findings. CONCLUSION In Hungary, acceptability of health problems increases with age and the majority found severe problems never acceptable. Views on acceptability of health problems seem to be fairly generalizable across European countries with different health and economic indicators.
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Affiliation(s)
- Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle Building, Office J8-51, PO Box 1738, 3000 DR, Rotterdam, The Netherlands. .,Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Zsombor Zrubka
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,Premium Postdoctoral Research Programme, Hungarian Academy of Sciences, Budapest, Hungary
| | - Werner B F Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle Building, Office J8-51, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.,Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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