Anne M. Stiggelbout, PhD and Yvette Peeters, MA. Leiden University Medical Center, Leiden, Netherlands
Purpose: Jansen et al. (2000) found that health states were valued more positively when experienced than when imagined. They explained this by the “non-corresponding description” of the health state scenario. Insinga and Fryback (2003) confirmed this finding for EQ-5D scenarios. The differences seem due to positive valuations for other attributes not captured by scenarios. Purpose of our study was to investigate if patients value their own experienced health state higher than their own imagined EQ-5D scenario, and if ‘enriching' this scenario by adding personalized attributes leads to higher utilities. Methods: We asked 122 patients with rheumatoid arthritis to 1. value their “own health” during the previous week on a Time TradeOff (TTO) and a Visual Analog Scale (VAS); 2. fill in the EQ-5D for the previous week; 3. fill in distracting questionnaires; 4. value six EQ-5D scenarios, of which the fifth (unknown to them) represented their own health of the previous week; 5. value their own EQ-5D scenario (now identified as such) enriched by adding personalized attributes. Differences between the three utilities for the patient's health (steps 1, 4 and 5) were assessed by MANOVAs and paired t-tests. The effect of enriching the scenarios was also studied more in-depth by limiting the analyses to those patients who had added only negative or only positive attributes, respectively. Results: Patients evaluated their enriched scenario higher than the standard EQ-5D scenario: TTO M = 0.84 vs. M = 0.81, p = 0.03. Surprisingly, utilities of both patients with only negative aspects and of those with only positive aspects were higher in the enriched than in the standard scenario. Contrary to Jansen et al. and Insinga and Fryback, utilities for the patients “own health” (step 1) were not higher than EQ-5D utilities (step 4). Similar results were seen for all analyses when using the VAS. Conclusions: Since the difference between standard and enriched EQ-5D scenarios holds for both positive and negative aspects of life, it seems not so much to be explained by “non-corresponding description”, but by status quo bias: patients are unwilling to “trade” their “own” life.