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It is well known that different methods of eliciting the valuations attached to various health states, such as the Visual Analogue Scale (VAS) and the Time Trade Off (TTO), yield different results. This study gathers qualitative data from a group of 43 respondents who had previously taken part in a large scale national study which set out to elicit the values attached by individuals to various health states using both the VAS and the TTO techniques. The findings of this study raised three questions which are of particular interest here(1) Why are some states that are rated better than dead on the VAS often rated as worse than dead in TTO? (2) Why are some respondents unwilling to trade off any time at all in order to avoid a health state that they place below full health on the VAS? (3) Why are TTO valuations of older respondents for the more severe health states lower than those of the younger age groups? This study has uncovered qualitative evidence on each of these three key issues. Regarding the first question, many respondents did not appear to interpret a better than dead VAS score as a strict preference for spending 10 years in a health state over immediate death. Several different factors appeared to contribute towards this, an important one being the tendency of respondents to ignore the duration of the health state during the VAS task. Regarding the second question, there is evidence of the existence of a "threshold of tolerability" below which states would have to fall before some respondents would be willing to give up any time at all on the TTO. Regarding the last question, it appears that older respondents are less likely to find the worse than dead TTO scenario plausible than those in the younger age groups. However, whilst this may explain why older respondents attach lower worse than dead valuations to health states, it does not appear to account for the entire difference in TTO valuations between the two age groups. In addition, it appears that older respondents may be less prepared to live for the next 10 years in a diminished health state.

译文

众所周知,产生与各种健康状态相关的估值的不同方法,例如视觉模拟量表 (VAS) 和时间权衡 (TTO),会产生不同的结果。这项研究收集了一组43名受访者的定性数据,这些受访者以前曾参加过一项大规模的全国性研究,该研究旨在利用VAS和TTO技术得出个人对各种健康状态的重视。这项研究的结果提出了三个特别令人感兴趣的问题 (1) 为什么一些在VAS上被评为比死亡更好的州通常被评为比TTO中的死亡更糟糕?(2) 为什么有些受访者根本不愿意在任何时候进行权衡,以避免他们将VAS置于完全健康以下的健康状态?(3) 为什么在更严重的健康状态下,老年受访者的TTO估值低于年轻年龄组?这项研究发现了关于这三个关键问题的定性证据。关于第一个问题,许多受访者似乎并没有将比dead更好的VAS评分解释为严格偏爱在健康状态中度过10年而不是立即死亡。似乎有几个不同的因素对此做出了贡献,一个重要的因素是受访者倾向于忽略VAS任务期间健康状态的持续时间。关于第二个问题,有证据表明存在 “容忍阈值”,在某些受访者愿意在TTO上任何时候放弃之前,国家必须降低该阈值。关于最后一个问题,与年轻年龄组的受访者相比,年龄较大的受访者似乎不太可能发现比死亡更糟糕的情况。然而,尽管这可以解释为什么年龄较大的受访者对健康状况的评估低于死估值,但似乎并不能解释两个年龄组之间TTO估值的全部差异。此外,年龄较大的受访者似乎不太愿意在健康状况下降的情况下生活未来10年。

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