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Background/aims: Discrete choice experiments (DCEs) with either duration included an attribute or with dead included as an option can be used as a stand-alone approach to value health states. This paper reports on a DCE with both of these features to develop an EQ-5D-5L value set for Australia., Methods: A DCE was undertaken using a large Australian panel of internet respondents, from which a sample of more than 4000 Australian adults was chosen, stratified to be population representative on age and gender. The DCE contained 500 choice triplets, with two EQ-5D-5L health states with duration, and dead as the third option. Each respondent answered 12 choice sets from the 500, stating both the best and worst options from the three available. The design was constructed to estimate a utility algorithm with main effects plus some key interaction terms. A variety of approaches to parameterising interactions, and to anchoring the value set on the required 0-1 scale, were tested. A preferred Australian adult utility algorithm for use in cost-utility analysis was then generated., Results: In total, 4477 people completed at least one choice set and were included in the analysis. The results reflected the monotonic structure of the EQ-5D-5L, in that moving from no problems to extreme problems led to worsening utility in each dimension. Inclusion of interaction terms demonstrates that the disutility of the first dimension moving to a poor level (defined as either level 5, or level 4 or 5) had a large impact, but subsequent dimensions moving to a poor level had a relatively smaller disutility., Discussion: This work develops a value set for the EQ-5D-5L in Australia, and also provides a range of methodological insights which can inform future work using a stand-alone DCE to value health in other countries., (© 2023. The Author(s).)

Objective: This paper reports on the valuation of the classification system for the Quality-of-Life Aged Care Consumers (QOL-ACC) instrument using a discrete choice experiment (DCE) with duration with a large sample of older people receiving aged care services., Methods: A DCE with 160 choice sets of two quality-of-life state-survival duration combinations blocked into 20 survey versions, with eight choice sets in each version, was designed and administered through an on-line survey to older Australians receiving aged care services in home and via interviewer facilitation with older people in residential aged care settings. Model specifications investigating preferences with respect to survival duration and interactions between QOL-ACC dimension levels were estimated. Utility weights were developed, with estimated coefficients transformed to the 0 (being dead) to 1 (full health) scale to generate a value set suitable for application in quality assessment and for the calculation of quality-adjusted life-years for use in economic evaluation., Results: In total, 953 older people completed the choice experiment with valid responses. The estimation results from econometric model specifications indicated that utility increased with survival duration and decreased according to quality-of-life impairment levels. An Australian value set (range - 0.56 to 1.00) was generated for the calculation of utilities for all QOL-ACC states., Conclusion: The QOL-ACC is unique in its focus on measuring and valuing quality of life from the perspective of older people themselves, thereby ensuring that the preferences of aged care service users are the primary focus for quality assessment and economic evaluation., (© 2022. The Author(s).)

Purpose and Setting: Despite the label "generic" health state utility instruments (HSUIs), empirical evidence shows that different HSUIs generate different estimates of Health-Related Quality of Life (HRQoL) in the same person. Once a HSUI is used to generate a QALY, the difference between HSUIs is often ignored, and decision-makers act as if 'a QALY is a QALY is a QALY'. Complementing evidence that different generic HSUIs produce different empirical values, this study addresses an important gap by exploring how HSUIs differ, and processes that produced this difference. 15 developers of six generic HSUIs used for estimating the QOL component of QALYs: Quality of Well-Being (QWB) scale; 15 Dimension instrument (15D); Health Utilities Index (HUI); EuroQol EQ-5D; Short Form-6 Dimension (SF-6D), and the Assessment of Quality of Life (AQoL) were interviewed in 2012-2013., Principal Findings: We identified key factors involved in shaping each instrument, and the rationale for similarities and differences across measures. While HSUIs have a common purpose, they are distinctly discrete constructs. Developers recalled complex developmental processes, grounded in unique histories, and these backgrounds help to explain different pathways taken at key decision points during the HSUI development. The basis for the HSUIs was commonly not equivalent conceptually: differently valued concepts and goals drove instrument design and development, according to each HSUI's defined purpose. Developers drew from different sources of knowledge to develop their measure depending on their conceptualisation of HRQoL., Major Conclusions/contribution to Knowledge: We generated and analysed first-hand accounts of the development of the HSUIs to provide insight, beyond face value, about how and why such instruments differ. Findings enhance our understanding of why the six instruments developed the way they did, from the perspective of key developers of those instruments. Importantly, we provide additional, original explanation for why a QALY is not a QALY is not a QALY., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Discrete choice experiments with duration (DCE TTO ) can be used to estimate utility values for preference-based measures, such as the EQ-5D-5L. For self-completion, the health dimensions are presented in a standard order. However, for valuation, this may result in order effects. Thus, it is important to understand whether health state dimension ordering affects values. The aim of this study was to examine the importance of dimension ordering on DCE values using EQ-5D-5L., Methods: A choice experiment presenting two health profiles and a third immediate death option was developed. A three-arm study was used, with the same 120 choice sets presented online across each arm (n = 360 per arm). Arm 1 presented the standard EQ-5D-5L dimension order, arm 2 randomised order between respondents, and arm 3 randomised within respondents. Conditional logit regression was used to assess model consistency, and scale parameter testing was used to assess model poolability., Results: There were minor inconsistencies across each arm, but the magnitudes of the coefficients produced were generally consistent. Arm 3 produced the largest range of utility values (1 to -0.980). Scale parameter testing suggested that the models did not differ, and the data could be pooled. Follow-up questions did not suggest variation in terms of difficulty., Conclusions: The results suggest that the level of randomisation used in DCE health state valuation studies does not significantly impact values, and dimension order may not be as important as other study design issues. The results support past valuation studies that use the standard order of dimensions.

Purpose: To systematically compare, via ranking and best worst tasks, the relative importance of key dimensions of quality of life for younger and older people., Methods: A web-based survey was developed for administration to two Australia-wide community-based samples comprising younger people aged 18-64 years and older people aged 65 years and above. Respondents were asked to rank 12 quality of life dimensions. Respondents also completed a successive best worst task using the same 12 quality of life dimensions., Results: The relative importance of the quality of life dimensions differed for younger and older person samples. For older people, the ability to be independent and to have control over their daily lives were particularly important for their overall quality of life whereas for younger people, mental health was considered most important., Conclusions: Many interventions accessed by older people in geriatric medicine and aged care sectors have a broader impact upon quality of life beyond health status. The findings from this study indicate that a focus on broader aspects of quality of life may also be consistent with the preferences of older people themselves as to what constitutes quality of life from their perspective.

Background: This study examined the relationships between a newly developed older person-specific non-preference-based quality of life (QoL) instrument (Older People's Quality of Life brief questionnaire (OPQoL-brief)) and two generic preference-based instruments (the EQ-5D-3L Level (EQ-5D-3 L) and the Adult Social Care Outcomes Toolkit (ASCOT) in a community-dwelling population of Australian older people receiving aged care services., Methods: We formulated hypotheses about the convergent validity between the instruments (examined by Wilcoxon-Mann Whitney, Kruskal Wallis and Spearman's correlation tests) and levels of agreement (assessed using intra class correlation (ICC) and modified Bland-Altman plots based on normalized Z EQ-5D-3 L and ASCOT utilities and OPQoL-Brief summary scores)., Results: The utilities/summary scores for 87 participants (aged 65-93 years) were moderately but positively correlated. Moderate convergent validity was evident for a number of instrument dimensions with the strongest relationship (r = 0.57) between 'enjoy life' (OPQoL-Brief) and 'social contact' (ASCOT). The overall ICC was 0.54 and Bland-Altman scatter plots showed 3-6% of normalized Z-scores were outside the 95% limits of agreement suggesting moderate agreement between all three instruments (agreement highest between the OPQoL-Brief and the ASCOT)., Conclusions: Our results suggest that the OPQoL-Brief, the ASCOT and the EQ-5D_3L are suitable for measuring quality of life outcomes in community-dwelling populations of older people. Given the different constructs underpinning these instruments, we recommend that choice of instrument should be guided by the context in which the instruments are being applied. Currently, the OPQoL-Brief is not suitable for use in cost-utility analyses as it is not preference-based. Given their different perspectives, we recommend that both the ASCOT and the EQ-5D are applied simultaneously to capture broader aspects of quality of life and health status within cost-utility analyses within the aged care sector. Future research directed towards the development of a new single preference-based instrument that incorporates both health status and broader aspects of quality of life within quality adjusted life year calculations for older people would be beneficial.

Background: Cost-effectiveness analyses of interventions for older adults have traditionally focused on health status. However, there is increasing recognition of the need to develop new instruments to capture quality of life in a broader sense in the face of age-associated increasing frailty and declining health status, particularly in the economic evaluation of aged and social care interventions that may have positive benefits beyond health., Objective: To explore the relative importance of health and broader quality of life domains for defining quality of life from the perspective of older South Australians., Methods: Older adults (n=21) from a day rehabilitation facility in Southern Adelaide, South Australia attended one of two audio-recorded focus groups. A mixed methods (qualitative and quantitative) study design was adopted. The study included three main components. First was a general group discussion on quality of life and the factors of importance in defining quality of life. Second was a structured ranking exercise in which individuals were asked to rank domains from the brief Older People's Quality of Life (OPQOL-brief) questionnaire and Adult Social Care Outcomes Toolkit (ASCOT) in order of importance. Third, participants were asked to self-complete the EuroQol five-dimension (EQ-5D), a measure of health status, and two broader quality-of-life measures: the OPQOL-brief and ASCOT., Results: Mean scores on the EQ-5D, OPQOL-brief and ASCOT were 0.71 (standard deviation [SD] 0.20, range 0.06-1.00), 54.6 (SD 5.5, range 38-61) and 0.87 (SD 0.13, range 0.59-1.00), respectively, with higher scores reflecting better ratings. EQ-5D scores were positively associated with OPQOL-brief (Spearman's Rho: 0.730; p<0.01), but not ASCOT. Approximately half (52.4%) of the participants ranked either 'health' or 'psychological and emotional well-being' as the domain most important to their quality of life. However, one-third (33.3%) of the total sample ranked a non-health domain from the ASCOT or OPQOL-brief (safety, dignity, independence) as the most important contributing factor to their overall quality of life. Qualitative analysis of focus group transcripts supported the high value of both health-related (health, psychological well-being) and social (independence, safety) domains to quality of life., Conclusions: Older adults value both health and social domains as important to their overall quality of life. Future economic evaluations of health, community and aged-care services for older adults should include assessment of both health-related and broader aspects of quality of life.

Discrete choice experiments (DCEs) are being used increasingly in health economics to elicit preferences for products and programs. The results of such experiments have been used to calculate measures of welfare or more specifically, respondents' 'willingness to pay' (WTP) for products and programs and their 'marginal willingness to pay' (MWTP) for the attributes that make up such products and programs. In this note we show that the methods currently used to derive measures of welfare from DCEs in the health economics literature are not consistent with random utility theory (RUT), or with microeconomic welfare theory more generally. The inconsistency with welfare theory is an important limitation on the use of such WTP estimates in cost-benefit analyses. We describe an alternative method of deriving measures of welfare (compensating variation) from DCEs that is consistent with RUT and is derived using welfare theory. We demonstrate its use in an empirical application to derive the WTP for asthma medication and compare it to the results elicited from the method currently used in the health economics literature.