title: Differences in EQ-5D-3L health state valuations among patients with musculoskeletal diseases, health care professionals and healthy volunteers.
abstract: BACKGROUND
  Results from existing studies indicate that different respondent groups' health state valuations in cost-utility analyses are not equivalent.
  
  
  OBJECTIVE
  The objectives in our study were to analyse differences in health state valuations among three respondent groups in the context of medical rehabilitation in Germany.
  
  
  METHODS
  Using the time trade-off (TTO) technique, valuations of EQ-5D-3L health states were obtained from patients with musculoskeletal diseases, healthy volunteers and health care professionals. We used linear mixed models to predict TTO utilities and specified and tested interaction effects.
  
  
  RESULTS
  We identified statistically significant (p < 0.05) differences among the three groups in six out of 42 health states. On average, patients' TTO values were somewhat higher compared with other respondent groups. Most of these differences occurred in severe health states. Mean differences and mean absolute differences were 0.02 and 0.14 for patients vs healthy volunteers and 0.06 and 0.14 for patients vs health care professionals. Furthermore, significant effects among respondents were observed for seven of the 22 possible interactions describing differences between respondent groups. Coefficients associated with significant interaction effects ranged from 0.08 to 0.18 (absolute values).
  
  
  CONCLUSIONS
  The results of our study suggest that TTO valuations of health states differ depending on the specific respondent group from which valuations are obtained. On average, these differences were small. However, researchers and decision makers should remain aware of these differences when interpreting incremental cost-utility assessments.
authors.affiliation: Institute for Community Medicine, Section Methods in Community Medicine, University of Greifswald, Walther-Rathenau-Strasse 48, 17475, Greifswald, Germany. anja.schwalm@uni-greifswald.de.
authors.forename: Anja
authors.initials: A
authors.lastname: Schwalm
authors.affiliation: Institute for Community Medicine, Section Methods in Community Medicine, University of Greifswald, Walther-Rathenau-Strasse 48, 17475, Greifswald, Germany.
authors.forename: You-Shan
authors.initials: YS
authors.lastname: Feng
authors.affiliation: Competence Tandem PsychNetwork, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany.
authors.forename: Jörn
authors.initials: J
authors.lastname: Moock
authors.affiliation: Institute for Community Medicine, Section Methods in Community Medicine, University of Greifswald, Walther-Rathenau-Strasse 48, 17475, Greifswald, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kohlmann
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D005858:Germany; D006282:Health Personnel / Q000523:psychology*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000523:psychology* / Q000534:rehabilitation; D011787:Quality of Health Care; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Cost effectiveness; Health status; Patient preference; Quality of life; Quality-adjusted life years