title: How is the most severe health state being valued by the general population?
abstract: BACKGROUND
  It has been reported that valuation of health states that are close to death, such as the most severe health state, can be affected by health state valuation procedure, and their utility values are difficult to predict. We examined how the most severe health states of Short Form-6 dimension (SF-6D) and EuroQoL-5 dimension-3 level (EQ-5D-3L) were valued by the Singapore general population.
  
  
  METHODS
  Overall, 249 SF-6D and 42 EQ-5D-3L states were valued by two separate samples from the Singapore general population using the visual analogue scale (VAS) method. Ordinary least-square regression model was employed to explain deficit in the valuation of the most severe state using the health state descriptors.
  
  
  RESULTS
  A total of 1021 participants from the SF-6D sample and 1015 participants from the EQ-5D-3L sample were included in the analysis. We observed that 67% of the SF-6D participants and 74% of the EQ-5D-3L participants considered the most severe state worse than dead. The most severe state had mean VAS valuation scores more than 20-25 points lower than the adjacent states that are better by only one level in only one dimension. SF-6D VAS valuation score for the most severe state was 27 points and 12 points lower than expected according to the health state descriptors among the participants who considered the most severe state worse than dead and better than dead, respectively. Similar results were found for the EQ-5D-3L valuation.
  
  
  CONCLUSIONS
  The most severe health state was valued lower than expected according to its descriptors.
authors.affiliation: Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore. mihir.gandhi@scri.edu.sg.|Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore. mihir.gandhi@scri.edu.sg.|Department of International Health, School of Medicine, University of Tampere, Tampere, Finland. mihir.gandhi@scri.edu.sg.
authors.forename: Mihir
authors.initials: M
authors.lastname: Gandhi
authors.affiliation: Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore. julian.thumboo@sgh.com.sg.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. julian.thumboo@sgh.com.sg.
authors.forename: Julian
authors.initials: J
authors.lastname: Thumboo
authors.affiliation: Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore. phawhl@nus.edu.sg.
authors.forename: Hwee-Lin
authors.initials: HL
authors.lastname: Wee
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. ephln@nus.edu.sg.
authors.forename: Nan
authors.initials: N
authors.lastname: Luo
authors.affiliation: Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore. yinbun.cheung@duke-nus.edu.sg.|Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore. yinbun.cheung@duke-nus.edu.sg.|Department of International Health, School of Medicine, University of Tampere, Tampere, Finland. yinbun.cheung@duke-nus.edu.sg.
authors.forename: Yin-Bun
authors.initials: YB
authors.lastname: Cheung
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D012929:Psychological Distance; D011788:Quality of Life; D015203:Reproducibility of Results; D012846:Singapore; D019452:Terminally Ill / Q000523:psychology*; D064232:Visual Analog Scale