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Tuesday, 19 October 2004

This presentation is part of: Poster Session - Clinical Strategies; Judgment and Decison Making

VALUATION OF HEALTH USING TIME TRADE-OFF AND STANDARD GAMBLE: NON-TRADERS AND NON-GAMBLERS

ME Suarez-Almazor, MD, PhD1, J. Souchek, PhD1, M Byrne, PhD2, PA Kelly, PhD1, M Richardson, MSW1, C Pak, MS1, and H Nelson, MS1. (1) Baylor College of Medicine/Michael E. DeBakey VA Medical Center, Health Services Research, Houston, TX, (2) University of Pittsburgh, Medicine and Center for Bioethics and Health Law, Pittsburgh, PA

PURPOSE: To examine the characteristics of individuals unwilling to trade-off time or gamble in the valuation of health scenarios using time trade-off (TTO) or standard gamble (SG) methods.

METHODS: As part of a study eliciting preferences for arthritis states, we surveyed 391 individuals using TTO and SG: 193 were members of the public, identified by random digit dialing, and 198 were individuals diagnosed with osteoarthritis (OA). Participants rated two hypothetical scenarios of patients with OA (mild and severe), and own health. Individuals unwilling to trade or gamble to obtain perfect health were compared to the remainder subjects. Differences were analyzed with parametric and non-parametric univariate tests, and logistic regression.

RESULTS: For the mild OA scenario, 9.2 % of the subjects were unwilling to trade-off time for perfect health, and 14.3 % were unwilling to gamble. For the severe scenario, the percentages were 4.8 and 10.5% respectively. Statistically significant differences were observed between the public and patients, with patients being more willing to trade or gamble for perfect health. For own health, 9.1% of the patients and 17.6% of the public were non-traders (p=0.01); 11.6% of the patients and 26.4% of the public were non-gamblers (p<0.001). When compared to the other respondents, non-traders and non-gamblers were significantly more likely to be older, African-American, have lower educational status and difficulties in completing the survey. Religious beliefs, and self-reported health status (after controlling for being a member of the patient or public groups) were not associated with non-trader or non-gambler status.

CONCLUSIONS: A substantial proportion of individuals are unwilling to trade-off time or gamble for perfect health, especially if they have not experienced the disease being valued. These differences are associated with age, educational status and test performance, and raise equity concerns about eliciting preferences with the currently used techniques.


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