BACKGROUND:Utilities for health are measured on an interval scale, where 1 refers to full health and 0 refers to death. No theoretical lower boundary on the utilities for states worse than death exists. As a consequence, negative values receive greater weight in the calculation of mean utilities. To avoid this, negative values often are bound at -1. OBJECTIVE:The objective of this study was to compare the effect of 3 methods to bound negative values at -1 on the estimation of EQ-5D value sets: truncation, monotonic, and linear transformation. METHOD:Data of the Dutch EQ-5D valuation study were used. A total of 298 respondents directly valued 17 EQ-5D health states using the time trade-off (TTO) method. Random effects regression analysis was used to interpolate TTO values for all possible EQ-5D states. In the regression analysis the dependent variable is 1 minus the TTO value and the independent variables describe the health state. Two widely used models to estimate EQ-5D value were applied after truncation of negative values and monotonic and linear transformation of negative values. Both models also were estimated on medians. RESULTS:Truncation of negative values gave the largest mean absolute error (MAE); the linear transformation resulted in the smallest MAE. When medians were used for estimation, the MAEs were comparable with the estimation on means. CONCLUSION:The choice of a method to bound negative values is arbitrary and affects the resulting value set. For the estimation of EQ-5D value sets from a societal perspective the use of medians should be considered.

译文

背景:卫生实用程序是按时间间隔量度的,其中1表示完全健康,0表示死亡。没有比死亡更糟的国家效用的理论下界。因此,负值在平均效用计算中的权重更大。为避免这种情况,负值通常绑定在-1处。
目的:本研究的目的是比较截断,单调和线性变换对EQ-5D值集的估计的三种方法在-1处绑定负值的影响。
方法:使用荷兰EQ-5D评估研究的数据。共有298位受访者使用时间权衡(TTO)方法直接评估了17个EQ-5D健康状态。随机效应回归分析用于内插所有可能的EQ-5D状态的TTO值。在回归分析中,因变量为1减去TTO值,而自变量描述健康状况。在截断负值并进行负值的单调线性变换之后,应用了两个广泛使用的模型来估计EQ-5D值。两种模型均以中位数估算。
结果:截断负值给出最大的平均绝对误差(MAE);线性变换产生最小的MAE。当使用中位数进行估计时,MAE与平均值估计值具有可比性。
结论:绑定负值的方法的选择是任意的,并且会影响结果集。从社会角度评估EQ-5D值集时,应考虑使用中位数。

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