Background In economic evaluations, quality-adjusted life-years (QALYs) can serve as a unit of measurement for disease burden. Obtaining QALY values for COVID-19 presents a challenge owing to the availability of two US EQ-5D-5L value sets and the potentially asymptomatic presentation of the disease. The first value set was completed allowing for the discounting of future health outcomes while the second value set is undiscounted. Objective The objective of this study was to compare the distribution of QALY values using a national survey and the two published value sets; and to estimate the association between COVID-19 outcomes and QALY losses. Methods Between 9 and 11 November, 2020, 1153 US adults completed the EQ-5D-5L instrument (five items and a visual analog scale) as well as self-reported their demographics, COVID-19 symptoms, and memberships to populations that are at risk of COVID-19 infection. The two US value sets were applied to the EQ-5D-5L responses to produce QALY values. We estimated the mean QALYs by visual analog scale decile and a generalized linear model of COVID-19 outcomes. Results The discounted values are higher than the undiscounted values for each visual analog scale decile owing to methodological differences. Persons at increased risk, with a fever in the past day, and with one or more other symptoms have significantly greater QALY losses ( p < 0.01). Overall, non-institutionalized individuals at risk of symptomatic clinical COVID-19 equal 0.68 for the 2016 value set (95% confidence interval 0.49–0.87) and 0.10 for the 2017 value set (95% confidence interval − 0.31 to 0.51) QALYs. Conclusions Multiple studies have shown that decision makers discount future health outcomes, which increase QALY values. This study confronts the practical implications of these methodological advances for use in COVID-19 economic evaluations. Health economists will be able to use the QALY values in this study to better evaluate health interventions against COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00509-z.
Analyses of preference evidence frequently confuse heterogeneity in the effects of attribute parameters (i.e., taste coefficients) and the scale parameter (i.e., variance). Standard latent class models often produce unreasonable classes with high variance and disordered coefficients because of confounding estimates of effect and scale heterogeneity. In this study, we estimated a scale-adjusted latent class model in which scale classes (heteroskedasticity) were identified using respondents’ randomness in choice behavior on the internet panel (e.g., time to completion and time of day). Hence, the model distinctly explained the taste/preference variation among classes associated with individual socioeconomic characters, in which scales are adjusted. Using data from a discrete-choice experiment on US health insurance demand among single employees, the results demonstrated how incorporating behavioral data enhances the interpretation of heterogeneous effects. Once scale heterogeneity was controlled, we found substantial heterogeneity with 4 taste classes. Two of the taste classes were highly premium sensitive (economy class), coming mostly from the low-income group, and the class associated with better educational backgrounds preferred to have a better quality of coverage of health insurance plans. The third class was a highly quality-sensitive class, with a higher SES background and lower self-stated health condition. The last class was identified as stayers, who were not premium or quality sensitive. This case study demonstrates that one size does not fit all in the analysis of preference heterogeneity. The novel use of behavioral data in the latent class analysis is generalizable to a wide range of health preference studies.
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