A uniform time trade off method for states better and worse than dead: feasibility study of the 'lead time' approach

The way time trade off (TTO) values are elicited for states of health considered 'worse than being dead' has important implications for the mean values used in economic evaluation. Conventional approaches to TTO, as used in the UK's 'MVH' value set, are problematic because they require fundamentally different trade-offs tasks for the valuation of states better and worse than dead. This study aims to refine and test the feasibility of a new approach described by Robinson and Spencer (2006. Health Economics 15: 393-402), and to explore the characteristics of the valuation data it generates. The approach introduces a 'lead time' into the TTO, producing a uniform procedure for generating values either >0 or<0. We used this lead time TTO to value 10 moderate to severe EQ-5D states using a sample of the general public (n=109). We conclude that the approach is feasible for use in valuation studies and appears to overcome the discontinuity in values around 0 evident in conventional methods. However, further research is required to resolve the issue of how to handle participants who 'use up' all lead time; to develop ways of controlling for individual time preferences; and to better understand the implications for valuations of states better than dead.