Purpose: To examine the effect of caregiver status on time trade-off (TTO) and standard gamble (SG) valuations of osteoarthritis health states of varying severity.
Methods: Participants were 80 individuals from the UK general population (mean age = 47.3 years; 51.3% male). Of these, 30 indicated that one or more individuals (e.g., children and/or elderly or disabled relatives) were dependent on them for care. Participants rated three osteoarthritis health-state descriptions (10-year time horizon), representing mild, moderate, and severe disease, using both the TTO and the SG. Comparison of health-state scores for participants with and without dependents was made using independent t-tests.
Results: Compared to participants without dependents, participants with dependents were more likely to be male (p = 0.03), and married or separated rather than single (p < 0.02). Participants with dependents assigned higher mean (SD) TTO scores than those without dependents for all three osteoarthritis health states: 0.92 (0.06) vs. 0.85 (0.13) for mild (p < 0.01), 0.84 (0.19) vs. 0.76 (0.23) for moderate (p = 0.11) and 0.69 (0.28) vs. 0.53 (0.29) for severe disease (p = 0.03). A similar pattern was observed for mean SG utility scores: 0.93 (0.05) vs. 0.90 (0.12) for mild (p = 0.16), 0.89 (0.10) vs. 0.84 (0.20) for moderate (p = 0.13) and 0.79 (0.19) vs. 0.61 (0.33) for severe disease (p < 0.01). Participants with dependents were less likely to trade any time in the TTO task than participants without dependents (with a statistically significant between-group difference for the mild and severe health states). For example, only 23.3% of respondents with dependents were willing to trade time to avoid living in the mild osteoarthritis health state, compared with 46.0% of respondents without dependents (p < 0.05).
Conclusions: Individuals in the caregiver role appear to be less willing than those who are not to trade time or gamble to improve their personal health, a disinclination most evident for valuations of the most severely affected health state. Caregivers’ attempts to maximize “household utility” (concern for the welfare of others as well as themselves) may contribute to the heterogeneity in the distribution of health state utilities.
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