title: Influenced from the start: anchoring bias in time trade-off valuations.
abstract: The de facto standard method for valuing EQ-5D health states is the time trade-off (TTO), an iterative choice procedure. The TTO requires a starting point (SP), an initial offer of time in full health which is compared to a fixed offer of time in impaired health. From the SP, the time in full health is manipulated until preferential indifference. The SP is arbitrary, but may influence respondents, an effect known as anchoring bias. The aim of the study was to explore the potential anchoring effect and its magnitude in TTO experiments.
  
  
  
  A total of 1249 respondents valued 8 EQ-5D health states in a Web study. We used the lead time TTO (LT-TTO) which allows eliciting negative and positive values with a uniform method. Respondents were randomized to 11 different SPs. Anchoring bias was assessed using OLS regression with SP as the independent variable. In a secondary experiment, we compared two different SPs in the UK EQ-5D valuation study TTO protocol.
  
  
  
  A 1-year increase in the SP, corresponding to an increase in TTO value of 0.1, resulted in 0.02 higher recorded LT-TTO value. SP had little impact on the relative distance and ordering of the eight health states. Results were similar to the secondary experiment.
  
  
  
  The anchoring effect may bias TTO values. In this Web-based valuation study, the observed anchoring effect was substantial. Further studies are needed to determine whether the effect is present in face-to-face experiments.
authors.affiliation: Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Postboks 1089, Blindern, 0317, Oslo, Norway. livariane@gmail.com.|Health Services Research Center, Akershus University Hospital, Akershus, Norway. livariane@gmail.com.
authors.forename: Liv Ariane
authors.initials: LA
authors.lastname: Augestad
authors.affiliation: Health Services Research Center, Akershus University Hospital, Akershus, Norway.|Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway.|Medical Faculty, Faculty Division, Akershus University Hospital, University of Oslo, Lørenskog, Norway.
authors.forename: Knut
authors.initials: K
authors.lastname: Stavem
authors.affiliation: Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Postboks 1089, Blindern, 0317, Oslo, Norway.
authors.forename: Ivar Sønbø
authors.initials: IS
authors.lastname: Kristiansen
authors.affiliation: Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Postboks 1089, Blindern, 0317, Oslo, Norway.
authors.forename: Carl Haakon
authors.initials: CH
authors.lastname: Samuelsen
authors.affiliation: Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Postboks 1089, Blindern, 0317, Oslo, Norway.|Health Services Research Center, Akershus University Hospital, Akershus, Norway.
authors.forename: Kim
authors.initials: K
authors.lastname: Rand-Hendriksen
mesh_terms: D000328:Adult; D015982:Bias; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Anchoring bias; EQ-5D; Health state valuation; Starting point; Time trade-off