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A Practical Method for Estimating Generalized Risk-Adjusted Cost-Effectiveness Utilities and Willingness-to-Pay

Anirban Basu1, Darius Lakdawalla2

  • 1The CHOICE Institute, University of Washington, Seattle, WA, USA.

Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research
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PubMed
Summary
This summary is machine-generated.

This study introduces a linear mapping to estimate Generalized Risk-Adjusted Cost-Effectiveness (GRACE) utilities from time tradeoff (TTO) measures. This method improves accuracy for health utilities, especially for severe health states, without new data collection.

Keywords:
Generalized Risk-Adjusted Cost-Effectivenesseconomic evaluationtime trade-off utilitiesvisual analog scale health

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Area of Science:

  • Health Economics
  • Decision Analysis
  • Biostatistics

Background:

  • Standard health utility measures often neglect risk preferences.
  • Generalized Risk-Adjusted Cost-Effectiveness (GRACE) incorporates risk preferences but typically requires Visual Analogue Scale (VAS) health state utilities.
  • VAS measures may not always be available to analysts.

Purpose of the Study:

  • To develop an empirical method for deriving GRACE utilities from readily available Time Tradeoff (TTO) utilities.
  • To enable the use of GRACE in cost-effectiveness analyses when only TTO data exists.
  • To provide a practical solution for adjusting willingness-to-pay thresholds based on TTO-derived GRACE values.

Main Methods:

  • Utilized nationally representative patient-level data containing both VAS and TTO health state measures.
  • Estimated a linear regression model to map TTO utilities to VAS utilities.
  • Applied published GRACE utility estimates and the derived TTO-to-VAS mapping to create TTO-to-GRACE utility conversions.

Main Results:

  • A linear model demonstrated the most effective mapping between TTO and VAS health state utilities.
  • TTO utilities closely approximate VAS utilities for moderate health states but show greater error for less moderate states.
  • TTO utilities systematically underestimate VAS health utilities for severe health states (TTO < 0.4).

Conclusions:

  • A simple linear mapping allows estimation of GRACE utilities using conventional TTO measures.
  • Existing studies relying solely on TTO utilities may underestimate the GRACE value of health improvements in severely ill populations.
  • This approach provides a method to calculate GRACE and adjust willingness-to-pay thresholds without generating new patient data.