Automated Current Health Time-Trade-Off Assessments in Women’s Health

Authors

  • Anna N. A. Tosteson ScD,

    1. Center for the Evaluative Clinical Sciences, Department of Community and Family Medicine and Clinical Research Section, Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire;
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  • Terry S. Kneeland MPH,

    1. Center for the Evaluative Clinical Sciences, Department of Community and Family Medicine and Clinical Research Section, Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire;
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  • Robert F. Nease PhD,

    1. Laboratory for Medical Decision Sciences Washington University School of Medicine, St. Louis, Missouri
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  • Walton Sumner MD

    1. Laboratory for Medical Decision Sciences Washington University School of Medicine, St. Louis, Missouri
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Address correspondence to: Anna N. A. Tosteson, ScD, HB7505 Clinical Research, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756. E-mail: anna.tosteson@dartmouth.edu

Abstract

Abstract

Objective

To motivate the role for preference assessment in women’s health and to report pilot data addressing the performance of automated time-trade-off (TTO) valuations of current health, which were developed to estimate quality-adjusted life years (QALYs) in the women’s health setting.

Methods

Values for current health relative to perfect health and death were assessed using an annual time trade-off (1-year horizon and sleep as the trading metaphor), a lifetime time trade-off, and a visual analog scale (VAS). All instruments were administered twice within a 12- to 14-day window among a convenience sample of 27 women.

Results

Valuation of health was similar for both time trade-offs (mean of 0.95 for both), but was significantly lower for the VAS (mean of 0.84, Wilcoxon signed-rank p-value < 0.001). Reliability using the intraclass correlation coefficient was 0.67 ± 0.09 and 0.75 ± 0.07 for the annual and lifetime time trade-offs, respectively, and 0.89 ± 0.03 for the VAS. Construct validity was supported by consistent trends in time-trade-off utilities across tertiles of the Short Form 36 (SF-36) general health subscale (trend test p-value < 0.001).

Conclusion

Automated time trade-offs for current health provide a promising approach for use in women’s health studies where impact on QALYs must be measured. Natural areas of application include the economic evaluation of preventive interventions in postmenopausal women.

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