Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
Unidad de Análisis y Generación de Evidencias en Salud Pública, Instituto Nacional de la Salud, Lima, Perú.
Value Health. 2020 Jul;23(7):880-888. doi: 10.1016/j.jval.2020.05.004. Epub 2020 Jul 18.
OBJECTIVES: (1) To produce Peruvian general population EQ-5D-5L value sets on a quality-adjusted life-year scale, (2) to investigate the feasibility of a "Lite" protocol less reliant on the composite time trade-off (cTTO), and (3) to compare cTTO and discrete choice experiment (DCE) value sets. METHODS: A random sample of adults (N = 1000) in Lima, Arequipa, and Iquitos did a home interview; 300 were randomly selected to complete 11 cTTOs first. All respondents completed a DCE, including 10 latent-scale pairs (A/B) with 5 EQ-5D-5L attributes, and 12 matched pairs (A/B and B/C) with 5 EQ-5D-5L and one lifespan attributes. We estimated a cTTO heteroscedastic tobit (N = 300) model and 3 DCE Zermelo-Bradley-Terry models (N = 300, 700, and 1000). RESULTS: Each model produced a consistent value set (20 positive incremental parameters). Nevertheless, their lowest quality-adjusted life-year values differed greatly (cTTO: -1.076 [N = 300]; DCE: -0.984 [300], 0.048 [700], -0.213 [1000]). Compared with the cTTO, the DCE (N = 300) produced different parameters (Pearson's correlation = 0.541), fewer insignificant parameters (0 vs 8), and fewer values less than 0 (26% vs 44%). Compared with the DCE (N = 300), the DCE (N = 700) produced higher values but similar parameters (Pearson's correlation = 0.800). CONCLUSIONS: Besides producing EQ-5D-5L value sets for Peru, the results casts doubt about the feasibility of a Lite protocol like the one in this study. Additionally, fundamental differences between cTTO and DCE-without the existence of a gold standard-need further clarification. The choice between the two rational value sets produced in the current study is a matter of judgment and may have substantial policy implications.
目的:(1)生成秘鲁一般人群 EQ-5D-5L 值集,以质量调整生命年为单位;(2)研究对综合时间权衡(cTTO)依赖性较低的“简化”方案的可行性;(3)比较 cTTO 和离散选择实验(DCE)值集。
方法:利马、阿雷基帕和伊基托斯的随机样本成年人(N=1000)进行了家庭访谈;随机选择 300 人首先完成 11 次 cTTO。所有受访者都完成了 DCE,包括 10 个潜在尺度对(A/B)和 5 个 EQ-5D-5L 属性,以及 12 个匹配对(A/B 和 B/C)和 5 个 EQ-5D-5L 和一个寿命属性。我们估计了一个 cTTO 异方差 Tobit 模型和 3 个 DCE Zermelo-Bradley-Terry 模型(N=300、700 和 1000)。
结果:每个模型都产生了一个一致的价值集(20 个正增量参数)。然而,它们的最低质量调整生命年值差异很大(cTTO:-1.076[N=300];DCE:-0.984[300],0.048[700],-0.213[1000])。与 cTTO 相比,DCE(N=300)产生了不同的参数(皮尔逊相关系数=0.541)、更少的无显著参数(0 对 8)和更少的小于 0 的值(26%对 44%)。与 DCE(N=300)相比,DCE(N=700)产生了更高的值,但参数相似(皮尔逊相关系数=0.800)。
结论:除了为秘鲁生成 EQ-5D-5L 值集外,结果还对本研究中类似的简化方案的可行性提出了质疑。此外,cTTO 和 DCE 之间的根本差异——没有黄金标准——需要进一步澄清。在当前研究中产生的这两个合理价值集之间的选择是一个判断问题,可能具有重大政策意义。
Value Health. 2019-5-25
Value Health. 2016-6
Health Qual Life Outcomes. 2017-2-20
Health Qual Life Outcomes. 2023-1-2
Health Qual Life Outcomes. 2024-7-2
Med Decis Making. 2018-11
Health Qual Life Outcomes. 2025-6-15
Pharmacoeconomics. 2025-5-21
Qual Life Res. 2025-2
Eur J Health Econ. 2024-8
Pharmacoeconomics. 2023-11
Appl Health Econ Health Policy. 2023-5
Health Qual Life Outcomes. 2023-1-2
Pharmacoeconomics. 2023-3