PURPOSE:Health state values are by convention anchored to 'perfect health' and 'death.' Attitudes toward death may consequently influence the valuations. We used attitudes toward euthanasia (ATE) as a sub-construct for attitudes toward death. We compared the influence on values elicited with time trade-off (TTO), lead-time TTO (LT-TTO) and visual analogue scale (VAS).Since the 'death' anchor is most explicit in TTO, we hypothesized that TTO values would be most influenced by ATE. METHODS:Respondents valued eight EQ-5D health states with VAS, then TTO (n = 328) or LT-TTO (n = 484). We measured ATE on a scale from -2 (fully disagree) to 2 (fully agree) and used multiple linear regressions to predict VAS, TTO, and LT-TTO values by ATE, sex, age, and education. RESULTS:A one-point increase on the ATE scale predicted a mean TTO value change of -.113 and LT-TTO change of -.072. Demographic variables, but not ATE, predicted VAS values. CONCLUSIONS:TTO appears to measure ATE in addition to preferences for health states. Different ways of incorporating death in the valuation may impact substantially on the resulting values. 'Death' is a metaphysically unknown concept, and implications of attitudes toward death should be investigated further to evaluate the appropriateness of using 'death' as an anchor.

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目的:按照惯例,将健康状态值锚定为“完美健康”和“死亡”。因此,对死亡的态度可能会影响估值。我们将对安乐死的态度(ATE)作为对死亡态度的子构造。我们比较了时间权衡(TTO),提前期TTO(LT-TTO)和视觉模拟量表(VAS)对价值产生的影响。由于``死亡''锚在TTO中最为明确,因此我们假设TTO值受ATE影响最大。
方法:受访者使用VAS评估了八个EQ-5D健康状态,然后是TTO(n = 328)或LT-TTO(n = 484)。我们以从-2(完全不同意)到2(完全同意)的量度了ATE,并使用多元线性回归通过ATE,性别,年龄和学历来预测VAS,TTO和LT-TTO值。
结果:ATE量表上的单点上升预测平均TTO值变化为-.113,而LT-TTO变化为-.072。受众特征变量(而不是ATE)是预测的VAS值。
结论:除了对健康状态的偏好外,TTO似乎还可以测量ATE。将死亡纳入估值的不同方式可能会严重影响最终价值。 “死亡”是一个形而上学上未知的概念,应进一步研究对死亡态度的影响,以评估使用“死亡”作为锚点的适当性。

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