Time trade-off and attitudes toward euthanasia: implications of using 'death' as an anchor in health state valuation.
OBJECTIVE
Health state values are by convention anchored to 'perfect health' and 'death.' Attitudes toward death may consequently influence the valuations. We used attitudes toward euthanasia (ATE) as a sub-construct for attitudes toward death. We compared the influence on values elicited with time trade-off (TTO), lead-time TTO (LT-TTO) and visual analogue scale (VAS).Since the 'death' anchor is most explicit in TTO, we hypothesized that TTO values would be most influenced by ATE.


METHODS
Respondents valued eight EQ-5D health states with VAS, then TTO (n = 328) or LT-TTO (n = 484). We measured ATE on a scale from -2 (fully disagree) to 2 (fully agree) and used multiple linear regressions to predict VAS, TTO, and LT-TTO values by ATE, sex, age, and education.


RESULTS
A one-point increase on the ATE scale predicted a mean TTO value change of -.113 and LT-TTO change of -.072. Demographic variables, but not ATE, predicted VAS values.


CONCLUSIONS
TTO appears to measure ATE in addition to preferences for health states. Different ways of incorporating death in the valuation may impact substantially on the resulting values. 'Death' is a metaphysically unknown concept, and implications of attitudes toward death should be investigated further to evaluate the appropriateness of using 'death' as an anchor.
Health Services Research Centre, Akershus University Hospital, 1478, Lørenskog, Norway. l.a.augestad@medisin.uio.no
Liv A
LA
Augestad
Kim
K
Rand-Hendriksen
Knut
K
Stavem
Ivar Sønbø
IS
Kristiansen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D005065:Euthanasia; D005260:Female; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008297:Male; D009664:Norway; D010147:Pain Measurement; D011594:Psychometrics / Q000379:methods; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012044:Regression Analysis; D012945:Social Values; D011795:Surveys and Questionnaires; D013997:Time Factors; D064232:Visual Analog Scale; D055815:Young Adult