Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, England, UK; Erasmus School of Health Policy & Management, Rotterdam, the Netherlands.
Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
Value Health. 2019 Nov;22(11):1311-1317. doi: 10.1016/j.jval.2019.07.013. Epub 2019 Sep 7.
Health economists ask members of the general public to value health states, but it is recognized that individuals construct their preferences during the valuation tasks. Conventional methods rely on one-off interviews that do not give participants time to reflect and deliberate on their preferences.
This study investigates the effect of reflection and deliberation on health state preferences using the EQ-5D questionnaire and time trade-off valuation method.
A novel concurrent explanatory mixed-methods design is used to investigate the explanation for the quantitative findings.
A total of 57 participants in the United Kingdom valued health states before and after a group-based deliberation exercise. There were large changes in health state values at the individual level, but the changes canceled out at the aggregate level. The mixed-methods findings suggest deliberation did not reveal new information or reduce inconsistencies in reasoning but rather focused on an exchange of personal subjective beliefs. In cases of disagreement, the participants accepted but did not adopt other participants' opinions. Participants remained uncertain about the relevance of their experiences and about their values.
The evidence suggests that reflection and deliberation, as designed in this study, are unlikely to result in large systematic changes of health state values. The uncertainties expressed by participants means future research should investigate whether preferences are informed or whether providing participants with more information helps them construct their preferences with more certainty. The mixed-methods design used is a promising design to help elucidate the reasons for quantitative findings.
健康经济学家要求普通民众对健康状况进行估值，但人们认识到，个体在进行估值任务时会构建自己的偏好。传统方法依赖于一次性访谈，没有给参与者时间来反思和审议他们的偏好。
本研究使用 EQ-5D 问卷和时间权衡估值法，考察反思和审议对健康状况偏好的影响。
采用新颖的并行解释性混合方法设计，研究定量发现的解释。
英国共有 57 名参与者在进行基于小组的审议练习前后对健康状况进行了估值。在个体层面上，健康状况的价值发生了很大的变化，但在总体层面上，这些变化相互抵消了。混合方法的研究结果表明，审议并没有揭示新的信息或减少推理中的不一致性，而是更多地关注个人主观信念的交流。在意见不一致的情况下，参与者接受但不采纳其他参与者的意见。参与者仍然对自己的经验和价值观的相关性感到不确定。
证据表明，正如本研究设计的那样，反思和审议不太可能导致健康状况价值的系统大幅变化。参与者所表达的不确定性意味着未来的研究应该调查偏好是否是知情的，或者是否向参与者提供更多信息有助于他们更确定地构建自己的偏好。所使用的混合方法设计是一种有前途的设计，可以帮助阐明定量发现的原因。
