Experience-Based Values: A Framework for Classifying Different Types of Experience in Health Valuation Research

Article by: Patricia Cubí-Mollá

A new journal article by OHE’s Patricia Cubi-Molla and Koonal Shah, with Kristina Burström, was recently published in The Patient. The article proposes a new framework for classifying experience in health valuation research.

A common approach to the economic evaluation of health care is to measure the health benefits of the technology under evaluation in terms of quality-adjusted life years (QALYs), a generic measure that combines length of life with health-related quality of life. In order to express the latter quantitatively, numeric values are given to different health states, and these values are typically derived from preferences about how good or bad those health states are. However, the question of whose preferences should be used to derive the values is still an open debate.

A core thread of the debate focuses on eliciting values from the perspective of those who have experience with the health state being valued, or those who do not. Value sets purporting to present experience-based (EB) values are generally generated by asking the respondent to assess a health state described as your own health at the time of the preference elicitation. The concept of EB values is linked in the empirical literature to the idea of patients’ values. Conversely, in tasks collecting non-experience-based (non-EB) values, respondents are usually asked to value a set of explicitly described health states, imagining that they are living in those health states now and/or in the future. Non-EB values are usually linked to preferences derived from the general population. The choice of EB or non-EB values is of great importance, since it may affect the outcome of economic evaluations in health care. However, differences between EB and non-EB values are usually wrongly attributed to the experience component, disregarding the possibility that other factors—such as elapsed time since the experience, what is being valued, which frame is used or whose values are being derived—are likewise changing and may therefore explain part of the effect.

In a paper recently published in The Patient, OHE’s Patricia Cubi-Molla and Koonal Shah, in collaboration with Kristina Burström (Karolinska Institutet), propose a new framework to identify which elements contribute to the differences between EB and non-EB value sets. Based on a literature review, the authors identified the following key elements in a health valuation exercise: health state (what is valued?), reference person (whose health state is valued?), time frame (when?), group of raters (whose values?) and experience. The authors also elaborate the idea of EB values under the informed value or knowledge viewpoint, extending previous definitions of experience in health economics and outcomes literature. The new interpretation of experience is built on the frame of ‘‘embodied’’ (personal) or ‘‘empathetic’’ (vicarious) experiences as developed in the fields of sociology and anthropology. The classification framework is shown in the table below.

Categories

Question frame

Respondents

Elements

Health state (What?)

Reference person (Whose health state?)

Time frame (When?)

Raters (Whose values?)

Experience

Items

Health of a person without description

Health described using a multi-attribute instrument

Health described (other methods)

The respondent

Other person (similar to respondent)

Other person (known to respondent)

Other person (hypothetical to respondent)

Past

Present

Future

Public (representative sample)

Public (convenience sample)

Vested interest (patients)

Vested interest (others)

Personal experience (past)

Personal experience (present)

Personal experience (future)

Vicarious experience (affective)

Vicarious experience (non-affective)

No experience

The paper also explores how experience is tackled in different EB and non-EB value sets. The authors extract 49 valuation exercises from a total of 22 reviewed papers, and classify them according to the suggested framework.

This descriptive analysis reveals the following insights:

  • The role of experience reported in health valuation-related papers is frequently disregarded or, at most, minimised to the item of personal experience (present), linked to self-reported health.
  • Any sort of experience with the health state to be valued appears to be associated with higher values; however, there is contradictory evidence of whether this effect is greater for mild or severe health states.
  • The effect of personal experience on valuations seems to be larger than that of vicarious experience.
  • The valuation exercises where ‘‘patients’’ is the vested interest group offer a wider scope of perspectives than those valuation exercises addressed to the public.

The new interpretation of experience as personal or vicarious is aimed to enrich the discussion about the relationship between experienced health and health preferences.

For more information contact Patricia Cubi-Molla at OHE.

Cubi-Molla P, Shah K, Burström K. 2018 Experience-Based Values: A Framework for Classifying Different Types of Experience in Health Valuation Research. Patient. DOI | PubMed

Earlier versions of the research were presented at the 2017 EuroQol Plenary Meeting.

Posted in EQ-5D and PROMs, Research | Tagged External publications