The better than dead method: feasibility and interpretation of a valuation study.
BACKGROUND
Traditionally, the valuation of health states worse than being dead suffers from two problems: [1] the use of different elicitation methods for positive and negative values, necessitating arbitrary transformations to map negative to positive values; and [2] the inability to quantify that values are time dependent. The Better than Dead (BTD) method is a health-state valuation method where states with a certain duration are compared with being dead. It has the potential to overcome these problems.


OBJECTIVE
To test the feasibility of the BTD method to estimate values for the EQ-5D system.


METHODS
A representative sample of 291 Dutch respondents (aged 18-45 years) was recruited. In a web-based questionnaire, preferences were elicited for a selection of 50 different health states with six durations between 1 and 40 years. Random-effects models were used to estimate the effects of socio-demographic and experimental variables, and to estimate values for the EQ-5D. Test-retest reliability was assessed in 41 respondents.


RESULTS
Important determinants for BTD were a religious life stance [odds ratio 4.09 (2.00-8.36)] and the educational level. The fastest respondents more often preferred health-state scenarios to being dead and had lower test-retest reliability (0.45 versus 0.77 and 0.84 for fast, medium and slow response times, respectively). The results showed a small number of so-called maximal endurable time states.


CONCLUSIONS
Valuating health states using the BTD method is feasible and reliable. Further research should explore how the experimental setting modifies how values depend on time.
Department for Health Evidence, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands, Ralph.vanHoorn@radboudumc.nl.
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Donders
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Stalmeier
D000293:Adolescent; D000328:Adult; D001293:Attitude to Death; D005240:Feasibility Studies; D006305:Health Status Indicators; D006801:Humans; D020407:Internet; D008875:Middle Aged; D009426:Netherlands; D011594:Psychometrics / Q000379:methods; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D026712:Value of Life; D055815:Young Adult