An overview of the time trade-off method: concept, foundation, and the evaluation of distorting factors in putting a value on health

Lugnér, Anna K.; Krabbe, Paul F M

doi:10.1080/14737167.2020.1779062

Cited by 66 publications

(46 citation statements)

References 115 publications

(125 reference statements)

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“…While there are reasonable grounds for this decision (described above), it means that the DCE data collected will play no role in informing HTA decision making in Mexico. Further, the TTO technique is itself subject to limitations [38] (though it is worth noting that this is true of all stated preference methods). The cTTO and DCE data showed markedly different preference patterns (see Section 2 of the ESM Appendix for an overview of the DCE results).…”

Section: Discussionmentioning

confidence: 99%

EQ-5D-5L Health-State Values for the Mexican Population

Gutiérrez-Delgado

Galindo-Suárez

Cruz-Santiago

et al. 2021

Appl Health Econ Health Policy

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Objective To generate a value set for the Mexican adult general population to support and facilitate the inclusion of qualityadjusted life years (QALYs) into the health technology assessment process of the Mexican healthcare authorities. Methods A representative sample of the Mexican adult population stratified by age, sex and socio-economic status was used. Following version 2.0 of the EuroQol EQ-5D-5L valuation protocol, trained interviewers guided participants in completing composite time trade-off (cTTO) and discrete-choice experiment (DCE) tasks included in the EQ-VT software. Generalized least squares, Tobit and Bayesian models were used for cTTO data. The choice of value set model was based on criteria that included: theoretical considerations, parsimony, logical ordering of coefficients, and statistical significance. Results Based on quality control criteria and interviewer judgment, 1000 out of 1032 participants provided useable responses. Participants' demographic characteristics were similar to the 2010 Mexican Population Census and followed the socioeconomic structure defined by the Mexican Association of Marketing Research and Public Opinion Agencies (AMAI). The predicted index values in the final cTTO model (a heteroscedastic censored model with Bayesian estimation) ranged from − 0.5960 to 1, with 19.7% of all predicted health state scores less than 0 (i.e., worse than dead). Conclusion This study has generated the first value set representing the stated preferences of the Mexican adult population for use in estimating QALYs. The resulting EQ-5D-5L value set is technically robust and will facilitate health economic analyses as well as quality-of-life studies.

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Section: Discussionmentioning

confidence: 99%

EQ-5D-5L Health-State Values for the Mexican Population

Gutiérrez-Delgado

Galindo-Suárez

Cruz-Santiago

et al. 2021

Appl Health Econ Health Policy

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“…We cannot assume that it produces an interval scale; a conclusion that is reinforced by the lack of concordance by patients with the behavioral assumptions for respondents that underpin the scale. The current view is that any claim that the TTO has interval properties is by assertion and unsupported belief 27 .…”

Section: Ordinal Time Trade Off Scalesmentioning

confidence: 96%

Peter Rabbit is a Badger in Disguise: Deconstructing the Belief System of the Institute for Clinical and Economic Review in Health Technology Assessment

Langley

2021

Innov Pharm

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The Institute for Clinical and Economic Review (ICER), a Boston-based consulting group, has seen itself as the lead organization in the US for evaluating pharmaceuticals and, at product launch, making recommendations for pricing and access. Previous commentaries in Innovations in Pharmacy have made the case that the ICER analytical framework is nonsensical. It abandons the standards of normal science in favor of inventing evidence through unsupported assertions regarding measurement properties and lifetime assumption driven simulations. It has been labeled pseudoscience. Yet ICER persists in its belief that all preference scales have ratio properties. ICER believes it can disregard these standards, notably in respect of the axioms of fundamental evidence, and continue its technology assessment activities. Challenging a belief system is not undertaken lightly, although in the case of ICER the belief system is built on such shaky foundations that the effort seems almost superfluous. This deeply held belief, shared apparently by the majority of health economists according to ICER, that all preference scores have ratio properties with a true zero, is easily overturned: if it has ratio properties how is it that preferences scores have been known for over 30 years to recognize health states worse than death? In other words, they can have negative preferences. Recognizing this manifest contradiction is important because it brings into relief the wider belief system of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) who share the same mythical certainties. A key issue is one of cultural relativity: can we accept with equanimity the parallel existence of two belief systems in health technology assessment when one is clearly nonsense? The answer proposed here is clearly no; although unfortunately the blowback by ICER and ISPOR will ensure the survival at least in the near term of their unfortunate meme.

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“…• Ordinal Utilities: the failure to acknowledge that the preference scores are ordinal (e.g. TTO 13 ); that is, you can rank the scores but have no idea of the distance between them. ICER asserts that they are either interval or ratio; to support the imaginary I-QALY analysis they have to be ratio.…”

Section: Icer Pseudosciencementioning

confidence: 99%

Supping with the Devil: Belief and the Imaginary World of Multiple Myeloma Therapies Invented by the Institute for Clinical and Economic Review

Langley

2021

Innov Pharm

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Previous commentaries in Innovations in Pharmacy and other peer reviewed journals have made the case that the analytical framework, if that is not too strong a term, to support pricing and access recommendations endorsed by the Institute for Clinical and Economic Review (ICER) fails to meet the standards of normal science. By any criteria the ICER analysis is best described as pseudoscience; it fails the demarcation test between biological evolution and intelligent design. Like intelligent design it has its believers; a meme for all seasons. ICER is fully aware of the fact that it fails these standards, yet perseveres. It justifies its cost-per-QALY framework by maintaining, through unsubstantiated assertions, that it meets standards for scientific credibility; it denies the possibility of negative values and utilities which undercut completely the construction of QALYs. This is nonsense: not only does the ICER framework fail those standards, to include axioms of fundamental measurement, but also a simple rule of logic in basing its models on assumptions. ICER dogmatic adherence to simulation modeling is evidence in its latest report on multiple myeloma. The report is a charade; but unfortunately not one that is rejected by Bristol-Myer Squibb, GlaxoSmithKline, Sanofi and Amgen. Their responses to the draft evidence report points to their acceptance of imaginary simulation constructs to drive pricing decisions. Whether this reflects their unqualified acceptance of the imaginary simulation modelling to create evidence or a failure to appreciate the standards of normal science is unclear. Certainly, in this case they fail to recognize the devastating impact of believing in the use of the EQ-5D-5L preferences to create imaginary or I-QALYs. The question raised in this commentary is whether the willingness to accept the ICER analytical framework reflects a belief in the role of creating evidence, ICER style, or a willingness to accept ICER imaginary conclusions as the easy way out in negotiating prices with insurers and other payers. Accepting ICER imaginary constructs is an analytical dead end that will stifle the discovery of new facts. The question is: so what?

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An overview of the time trade-off method: concept, foundation, and the evaluation of distorting factors in putting a value on health

Cited by 66 publications

References 115 publications

EQ-5D-5L Health-State Values for the Mexican Population

EQ-5D-5L Health-State Values for the Mexican Population

Peter Rabbit is a Badger in Disguise: Deconstructing the Belief System of the Institute for Clinical and Economic Review in Health Technology Assessment

Supping with the Devil: Belief and the Imaginary World of Multiple Myeloma Therapies Invented by the Institute for Clinical and Economic Review

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