Krol Marieke, Sendi Pedram, Brouwer Werner
Department of Health Policy and Management, Erasmus University/Erasmus MC, Rotterdam, The Netherlands.
Value Health. 2009 Jan-Feb;12(1):172-80. doi: 10.1111/j.1524-4733.2008.00406.x. Epub 2008 Jul 18.
An underexplored question in the debate on incorporating productivity costs as costs or effects in a cost-effectiveness (CE) analysis is whether people include effects of ill health on income in health state valuations (HSV). The same holds for the actual inclusion in HSV of the effects of ill health on leisure. This study aims to test whether respondents to HSV using time trade-off (TTO) questions include income and leisure effects without instructions. Moreover, it tests the consequences of explicit instructions to include or exclude income effects.
Three questionnaires were administered among the general public. Respondents were asked to value three distinct EuroQol descriptive system health states using TTO. In version 1, respondents were asked afterwards whether they included income effects. In versions 2 and 3, respondents were instructed upfront to include or exclude income effects. They were furthermore asked whether they included leisure effects.
A total of 222 respondents completed the questionnaire. In version 1, 64% of the respondents spontaneously included income effects, not resulting in differences in mean valuations. In versions 2 and 3, 88% included leisure time, resulting in a significantly lower TTO value in one health state. With explicit instructions, respondents instructed to include income gave lower HSV for the worst health state presented.
Respondents in our sample did not consistently include income effects and leisure effects. Including income effects only had (some) effect on TTO valuations after an explicit instruction. If these results are confirmed in future research, this implies that income effects may be best captured on the cost-side of the CE ratio. Spontaneous inclusion or exclusion of leisure time appeared to be more influential.
在关于将生产力成本作为成本或效果纳入成本效益（CE）分析的辩论中，一个尚未充分探讨的问题是，人们在健康状态估值（HSV）中是否纳入了健康不佳对收入的影响。健康不佳对休闲的影响在HSV中的实际纳入情况也是如此。本研究旨在测试使用时间权衡（TTO）问题进行HSV调查的受访者在没有提示的情况下是否纳入收入和休闲影响。此外，它还测试了明确提示纳入或排除收入影响的后果。
对普通公众进行了三份问卷的调查。要求受访者使用TTO对三种不同的欧洲五维度健康量表（EuroQol）描述系统健康状态进行估值。在版本1中，之后询问受访者是否纳入了收入影响。在版本2和3中，预先提示受访者纳入或排除收入影响。此外，还询问他们是否纳入了休闲影响。
共有222名受访者完成了问卷。在版本1中，64%的受访者自发纳入了收入影响，但这并未导致平均估值的差异。在版本2和3中，88%的受访者纳入了休闲时间，导致一种健康状态下的TTO值显著降低。在有明确提示的情况下，被提示纳入收入影响的受访者对所呈现的最差健康状态给出了较低的HSV。
我们样本中的受访者并未始终如一地纳入收入影响和休闲影响。只有在明确提示后，纳入收入影响才对TTO估值有（一定）影响。如果这些结果在未来研究中得到证实，这意味着收入影响可能最好在CE比率的成本方面进行考量。休闲时间的自发纳入或排除似乎更具影响力。
