In the UK, the Measurement and Valuation of Health (MVH) value set (Dolan, 1997) is used to generate the quality-adjusted life year estimates to inform health technology assessment (HTA) decision making by NICE.
The values in the MVH set are based on the average preferences of a sample of the general public, elicited through time trade-off (TTO) tasks. However, many studies have found differences in the perception, measurement and valuation of health across groups of people of different ages.
One potential explanation for these differences could be the existence of framing effects linked to the TTO protocol used in the MVH study. However, even if such effects have been controlled for, individuals of different ages might perceive and interpret the same underlying state of health in different ways. An individual’s preferences and views about the goodness or badness of a given health state is likely to reflect their aspirations, expectations, fears and priorities, all of which may vary systematically with age.
These issues are explored in a new OHE Research Paper by Cubi-Molla et al. (2017) entitled: Age and Utilities: Issues for HTA. The aim of this research is to (a) extend the analysis of the relationship between age and utility in the MVH value set and (b) contribute to the existing debate about the rationale and implications for using age-specific utilities in HTA.
The authors use the TTO and visual analogue scale (VAS) values assigned to hypothetical health states in the MVH study. They find evidence that TTO values are indeed affected by the age of respondents.
A U-shaped age-utility pattern (with respondents in their forties tending to provide the highest values) is observed for the majority of the health states analysed. The TTO values obtained from the oldest respondents are systematically (and significantly, for the majority of profiles) lower than those obtained from younger age groups.
Differences in values amongst age groups seem to be associated with profiles with level 3 in the mobility dimension or level 2 or 3 in the self-care dimension. VAS valuations appear to be less affected by age than TTO valuations. This indicates that differences between the values of older and younger respondents may reflect the way that different age groups respond to different preference elicitation techniques.
Compared to previous research, this study analyses differences in utilities amongst a greater number of age-defined subgroups and at the individual health state level. It also examines how the findings relate to the various arguments for and against using age-specific utilities in HTA.
Download the full OHE Research Paper here.
For more information please contact Patricia Cubi-Molla at OHE.
Posted in EQ-5D and PROMs, Health Technology Assessment, NICE | Tagged undefined