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Trading people versus trading time: what is the difference?
Laura J Damschroder1, Todd R Roberts, Christine C Goldstein
1VA Health Service Research & Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. vancouvl@umich.edu
Population Health Metrics
|November 12, 2005
Summary
Person trade-off (PTO) elicitations reveal different values than time trade-off (TTO) measures. When lives are at stake, PTOs more frequently incorporate fairness principles like equality and non-discrimination.
Area of Science:
- Health Economics
- Decision Analysis
- Public Health
Background:
- Person trade-off (PTO) and time trade-off (TTO) elicitations yield differing utility values.
- This discrepancy may stem from PTOs capturing distributive justice principles beyond maximizing health benefits.
Purpose of the Study:
- To qualitatively assess if PTO elicitations elicit more non-QALY-maximizing distributive principles than TTO elicitations.
- To determine if this difference in principle consideration explains empirical value disparities.
Main Methods:
- 64 individuals participated in randomized, face-to-face interviews.
- Participants completed both TTO and PTO tasks, thinking aloud, across three treatment comparison contexts (life-saving, cure, or mixed).
Main Results:
- In life-saving treatment comparisons, 68% of participants considered non-maximizing principles in PTOs versus 5% in TTOs.
- Emergent principles included equality of life and avoiding discrimination.
- Participants were more likely to adopt a societal perspective with PTOs across all contexts.
Conclusions:
- PTO elicitations prompt consideration of non-maximizing principles, especially when life-saving treatments are involved.
- These principles encompass equal access, non-discrimination, and prioritizing the worse-off.
- This highlights PTOs' potential to reflect broader societal values in health-related decision-making.