PURPOSE: Patients with chronic health conditions usually place significantly higher utility on their own condition than the public. One explanation for this discrepancy is that healthy people focus on the negative aspects of the onset of the condition without considering that people can emotionally adapt to the condition over time. In previous research, we found that public raters gave significantly higher values for paraplegia after an adapataion exercise that was designed to encourage people to consider their own ability to adapt to difficult situations. This finding held true when using the rating scale or person tradeoff elicitation methods. In the current study, we tested whether this adaptation exercise would also influence people's responses using the time tradeoff (TTO) and standard gamble (SG) utility elicitation methods.

METHODS: We presented four scenarios to Internet users drawn from a demographically balanced U.S. panel. The scenarios asked respondents to give utilities for paraplegia, below-the-knee-amputation (BKA), colostomy, and severe pain. We randomly assigned subjects to one of four experimental groups in a 2 (SG or TTO utility elicitation method) by 2 (with or without an adaptation exercise) study design.

RESULTS: 1117 respondents participated in the study. Utilities derived from the TTO method were significantly higher than those obtained through the SG method (p<0.001). Respondents placed lowest utility on paraplegia and colostomy (0.73 and 0.74, respectively). Pain had an average utility of 0.79 while BKA had a utility of 0.84. In contrast to our earlier research, the adaptation exercise did not influence respondents' valuations (p=0.20). Respondents who indicated, during the adaptation exercise, that they believed the condition would become more upsetting over time placed lower utilities on that condition than other respondents (p<0.001).

CONCLUSIONS: People who did an adaptation exercise before rating four chronic health conditions, using the TTO or SG elicitation method, gave ratings that were the same as those who did not do the exercise. This finding is contrary to earlier research that used a similar adaptation exercise with other valuation methods. We speculate that thinking about adaptation changes people's evaluations of what it would feel like to live with chronic illness, but does not change how much they are willing to tradeoff in order to avoid that chronic illness.