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Eur J Health Econ. 2018 Dec 31. doi: 10.1007/s10198-018-1017-8. [Epub ahead of print]

Do time trade-off values fully capture attitudes that are relevant to health-related choices?

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Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK.
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK.
Norwich Medical School, University of East Anglia, Earlham Road, Norwich, NR4 7TJ, UK.
Department of Psychology, Durham University, Stockton Road, Durham, DH1 3LE, UK.
Department of Economics, Universidad de Navarra, 31009, Pamplona, Spain.


Previous research has shown that demographics, beliefs, and self-reported own health influence TTO values. Our hypothesis is that attitudes towards length and quality of life influence TTO values, but should no longer affect a set of related choices that are based on respondents' own TTO scores. A representative sample of 1339 respondents was asked their level of agreement to four statements relating to the importance of quality and length of life. Respondents then went on to value 4 EQ-5D 5L states using an online interactive survey and a related set of 6 pairwise health-related choice questions, set up, so that respondents should be indifferent between choice options. We explored the impact of attitudes using regression analysis for TTO values and a logit model for choices. TTO values were correlated with the attitudes and were found to have a residual impact on the choices. In particular, those respondents who preferred quality of life over length of life gave less weight to the differences in years and more weight to differences in quality of life in these choice. We conclude that although the TTO responses reflect attitudes, these attitudes continue to affect health-related choices.


Attitudes; Preference elicitation; TTO; Time trade-off method; Utility


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