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A threshold explanation for the lack of variation in negative composite time trade-off values

BACKGROUND: Recent studies concluded that for health states considered worse than dead (WTD), as measured with the time trade-off (cTTO) method, negative mean values were insensitive to health state severity, which represents a validity problem for the cTTO. However, the aforementioned studies analy...

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Autores principales: Roudijk, Bram, Donders, Rogier, Stalmeier, Peep
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9356942/
https://www.ncbi.nlm.nih.gov/pubmed/35622295
http://dx.doi.org/10.1007/s11136-022-03155-6
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author Roudijk, Bram
Donders, Rogier
Stalmeier, Peep
author_facet Roudijk, Bram
Donders, Rogier
Stalmeier, Peep
author_sort Roudijk, Bram
collection PubMed
description BACKGROUND: Recent studies concluded that for health states considered worse than dead (WTD), as measured with the time trade-off (cTTO) method, negative mean values were insensitive to health state severity, which represents a validity problem for the cTTO. However, the aforementioned studies analysed negative values in isolation, which causes selection bias as the value distribution is truncated. AIM: To investigate the validity of aforementioned studies and of negative values in general. METHODS: The ‘threshold explanation’ was formulated: beyond a certain severity threshold, preferences change from better than dead (BTD) to WTD. This threshold differs between respondents. Thus, negative values across severity are obtained from different respondents, and responses added for higher severity contribute negative values close to zero, explaining the aforementioned insensitivity. This explanation was tested using data from the Dutch EQ-5D-5L valuation study. Respondents valued 10 health states. Based on respondents’ number of WTD preferences, segments were constructed, containing respondents with similar severity thresholds. Using regression models for each individual respondent, we examined the relation between values and severity and compared respondents between segments. RESULTS: Negative values, when analysed in isolation, were insensitive to severity. However, for individual respondents and within most segments, cTTO values and severity were negatively related. For individual respondents, negative slopes were steeper for segments with more WTD preferences, as predicted by the threshold explanation. DISCUSSION: Analysing negative values in isolation leads to biased estimates. Analyses of cTTO values for individual respondents refute the insensitivity of negative cTTO values. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11136-022-03155-6.
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spelling pubmed-93569422022-08-08 A threshold explanation for the lack of variation in negative composite time trade-off values Roudijk, Bram Donders, Rogier Stalmeier, Peep Qual Life Res Article BACKGROUND: Recent studies concluded that for health states considered worse than dead (WTD), as measured with the time trade-off (cTTO) method, negative mean values were insensitive to health state severity, which represents a validity problem for the cTTO. However, the aforementioned studies analysed negative values in isolation, which causes selection bias as the value distribution is truncated. AIM: To investigate the validity of aforementioned studies and of negative values in general. METHODS: The ‘threshold explanation’ was formulated: beyond a certain severity threshold, preferences change from better than dead (BTD) to WTD. This threshold differs between respondents. Thus, negative values across severity are obtained from different respondents, and responses added for higher severity contribute negative values close to zero, explaining the aforementioned insensitivity. This explanation was tested using data from the Dutch EQ-5D-5L valuation study. Respondents valued 10 health states. Based on respondents’ number of WTD preferences, segments were constructed, containing respondents with similar severity thresholds. Using regression models for each individual respondent, we examined the relation between values and severity and compared respondents between segments. RESULTS: Negative values, when analysed in isolation, were insensitive to severity. However, for individual respondents and within most segments, cTTO values and severity were negatively related. For individual respondents, negative slopes were steeper for segments with more WTD preferences, as predicted by the threshold explanation. DISCUSSION: Analysing negative values in isolation leads to biased estimates. Analyses of cTTO values for individual respondents refute the insensitivity of negative cTTO values. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11136-022-03155-6. Springer International Publishing 2022-05-27 2022 /pmc/articles/PMC9356942/ /pubmed/35622295 http://dx.doi.org/10.1007/s11136-022-03155-6 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Roudijk, Bram
Donders, Rogier
Stalmeier, Peep
A threshold explanation for the lack of variation in negative composite time trade-off values
title A threshold explanation for the lack of variation in negative composite time trade-off values
title_full A threshold explanation for the lack of variation in negative composite time trade-off values
title_fullStr A threshold explanation for the lack of variation in negative composite time trade-off values
title_full_unstemmed A threshold explanation for the lack of variation in negative composite time trade-off values
title_short A threshold explanation for the lack of variation in negative composite time trade-off values
title_sort threshold explanation for the lack of variation in negative composite time trade-off values
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9356942/
https://www.ncbi.nlm.nih.gov/pubmed/35622295
http://dx.doi.org/10.1007/s11136-022-03155-6
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