Thirty down, only ten to go?! Awareness and influence of a 10-year time frame in TTO Floor van...
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![Page 1: Thirty down, only ten to go?! Awareness and influence of a 10-year time frame in TTO Floor van Nooten, Xander Koolman, Werner Brouwer 1 A paper introduced.](https://reader036.fdocuments.us/reader036/viewer/2022081401/5697bfcf1a28abf838caa3fb/html5/thumbnails/1.jpg)
Thirty down, only ten to go?! Awareness and influence of a 10-year
time frame in TTO
Floor van Nooten, Xander Koolman, Werner Brouwer
1
A paper introduced by Jan van Busschbach
LoLa, xx May 2010
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Time Trade-Off
Wheelchair With a life expectancy: 50 years
How many years would you trade-off for a cure?
Max. trade-off: 10 years
QALY(wheel) = QALY(healthy) Y * V(wheel) = Y * V(healthy) 50 V(wheel) = 40 * 1.00
V(wheel) = 0.80
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Does the time frame matters?
1. Wheelchair, life expectancy: 50 years Max. trade-off: 10 years 50 V(wheel) = 40 * 1.00 V(wheel) = 0.80
2. Wheelchair, life expectancy: 10 years Max. trade-off: 2 years 10 V(wheel) = 8 * 1.00 V(wheel) = 0.80
3. Wheelchair, normal life expectancy: 50 years, but trade-off limited to 10 years
After 10 years you die anyway Irrespectively of real live expectancy
Research justification: Is option 3 the same as 1 and/or 2?
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Indeed time frames matters…
From earlier research1. Life time, long life expectancy: the lowest values
2. Life time, short life expectancy: higher values
3. Forced short life expectancy: even higher values
That is: If indeed subjects follow instructions….
Given that the instructions are complex… Especially with forced short life expectancy …
Research questions Forced short life is often used…. Do subjects adhere to forced short life expectancy
instructions?
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Different “emphasis” on instruction forced short life
RCT, using 10 years life year framing N = 656 Internet survey
Q1: Control condition No addition emphasis on 10 years life Debriefing afterwards: “What were you thinking?”
Q2: Experimental condition Added emphasis on forced short life
3 EQ-5D health state valuations with TT0 TTO1: 21211 TTO2: 22221 TTO3: 33312
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Results: table 2
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Questionnaire Q1 Q2 pN 339 317Percentage non-traders per TTOTTO1 78.2% 83.9% 0.073TTO2 71.1% 79.5% 0.01
5TTO3 23.0% 46.7% 0.00
0Years traded-offTTO1 0.443 (SD
1.223)0.401 (SD
1.293)0.085
TTO2 0.552 (SD 1.182)
0.546 (SD 1.455)
0.036
TTO3 2.083 (SD 2.362)
1.467 (SD 2.266)
0.000
Less subjects start trade off when explicit instruction about 10 year survival are given
Trade offs are higher when explicit instruction about 10 year survival are given
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Additional results
Debriefing control condition Q1 43% did not think of forced short life…
Those who remembered instructions… TTO1: 21211….
• Lower values… not what might be expected TTO2: 22221….
• Higher values… but (univariate) not significant TTO3: 33312….
• Higher values… but (univariate) not significant
Multivariate ONLY TT02 & TTO 3… Significant results
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Additional results
Higher education: lower values Known already…
No age effect Known already…
Men trade off more: lower values New
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Conclusions
Subject forget instructions In the control condition, forced short life time is forgotten in 43% of
cases
Instructions matter Higher values with explicit instructions Those who forget, give lower values
Influence back ground variables Women (mothers) trade off less Higher education trade of more
Main conclusion: “These findings emphasize the importance of expected and
implied life expectancy in TTOs and raise important questions regarding the optimal design of TTO exercises.”
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Some problems…
Generalizability is over stretched 10 years life frame is rare Design is not a replication of that rare design
The relevance is over stretched Difference found are small Only in states with a low value
Back ground variables no part of research question No testing whether 10 years is a good thing Main conclusion should be:
• “These findings emphasize the importance of explicit instructions of implied life expectancy in TTOs with bad health states”
In stead of • “These findings emphasize the importance of expected and implied
life expectancy in TTOs and raise important questions regarding the optimal design of TTO exercises.”
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10 years life frame is rare
Forced short life is only used in some cases “Commonly, time trade-off (TTO) exercises use a 10-year time
horizon,…” “conventional TTO”
But this is only true for EQ-5D, MVH-protocol MVH-protocol is used a lot….
In EQ-5D and its translations
But others use different time frames SF-6D (SG) AQoL ? HUI ? 12D (VAS) Disease specific : IPSS, IIEF, …life time
Provide indications for which instruments it applies…
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Design is not a replication of the relevant earlier research
MVH-protocol differs from current design Is mentioned ones…
MVH is interview, not internet based There are explicit instruction in the interview about the 10
years
MVH used visual add The 10 life year span is visual
MVH allows for negative values
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Explicit instructions
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Visual add (prop)
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The design does not replicate
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Questionnaire Q1 Q2 pN 339 317UtilityTTO1 21211 (MVH value)
0.956 (0.814) 0.960 0.085
TTO2 22221 (MVH value)
0.945 (0.587) 0.945 0.036
TTO3 33312 (MVH value)
0.792 (-0.043) 0.853 0.000
“This point is emphasized by the fact that the utility scores obtained in our study are relatively high, when for instance compared to MVH_A1 scores…”
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Are the differences relevant?
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Questionnaire Q1 Q2 pN 339 317UtilityTTO1 0.956 (SD
0.122)0.960 (SD
0.129)0.085
TTO2 0.945 (SD 0.118)
0.945 (SD 0.145)
0.036
TTO3 0.792 (SD 0.236)
0.853 (SD 0.227)
0.000
No statistical significance
No relevant difference
Could be relevant
TTO1 21211 (MVH value)
0.956 (0.814) 0.960 0.085
TTO2 22221 (MVH value)
0.945 (0.587) 0.945 0.036
TTO3 33312 (MVH value)
0.792 (-0.043) 0.853 0.000
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Man trade more than women
The “mother hypothesis” “Such response modes might be related
to the position women have or envisage to have in life (e.g., as mothers). “
Neo-Darwinism Not the research question
Girls just wanna have fun… Cyndi Lauper (1983)
Paul Kind Cyndi is right… British Medical Journal 1998;316:736-
41.
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Fishing party…..
Debriefing control condition Q1 43% did not think of forced short life…
Those who remembered instructions… TTO1: 21211….
• Lower values… not what might be expected TTO2: 22221….
• Higher values… but (univariate) not significant TTO3: 33312….
• Higher values… but (univariate) not significant
Multivariate ONLY TT02 & TTO 3… Significant results…
Leave this out…..
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Conclusions
Subject forget instructions In the control condition, forced short life time is forgotten in
43% of cases
Instructions matter Higher values with explicit instructions
Main conclusion: “These findings emphasize the importance of explicit
instructions of implied life expectancy in TTOs with bad health states”
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