PREFERENCE ELICITATION USING TTO AND DCE: WHO FINDS WHICH TASKS MORE DIFFICULT?
Author(s)
Annika L. Pickard, MS, Jonathan L. Nazari, PharmD, PhD, Aaron N. Winn, MPP, PhD, A Simon Pickard, PhD.
Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago Retzky College of Pharmacy, Chicago, IL, USA.
Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago Retzky College of Pharmacy, Chicago, IL, USA.
OBJECTIVES: Preference-based measures, such as the EQ-5D, are valued using time trade-off (TTO) or discrete choice experiment (DCE) tasks. Understanding task difficulty across populations, particularly among those with lower education or health literacy, facilitates informed preferences. This study aimed to: (1) compare TTO and DCE across three matched aspects of task difficulty, and (2) identify associated sociodemographic factors.
METHODS: EQ-5D-5L US valuation data (n=1133) were analyzed. Respondents completed 15 TTO and 7 DCE tasks, each followed by three 5-level items rating difficulty: understanding the task, ability to differentiate between health state scenarios, and deciding on a preferred state/indifference point. Ordinal logistic regression models examined associations between difficulty items and age, gender, race, education, comorbidities, and health literacy (Brief Health Literacy Screener). Covariate-adjusted linear models explored within-person TTO-DCE differences in between-task difficulty.
RESULTS: Mean age was 48 years (SD: 14); 52% were female; 32% had inadequate/marginal health literacy. Difficulty understanding the task was reported by 3.8% (TTO) vs 1.5% (DCE); differentiating health states, 29.2% vs 4.0%; and deciding on a response, 88.2% vs 44.0%. TTO was more difficult than DCE across all three dimensions of difficulty (mean differences 0.22-1.29; effect size=0.29-0.81). Generally, older age, lower education, non-white race, and lower health literacy were associated with greater difficulty for both TTO and DCE tasks. DCE was relatively more difficult than TTO to understand for age 55+ (Beta -0.13, p=0.03), ref: age 18-34), and males (Beta -0.11, p=0.02).
CONCLUSIONS: Overall, TTO tended to be substantially more difficult than DCE for all 3 criteria related to task difficulty, although some sociodemographic factors increased or mitigated the magnitude of difference in perceived difficulty between tasks. Given the very limited explanatory power of the models, results suggest that socio-demographics have limited role in the perceived difficulty of the TTO and DCE as health valuation tasks.
METHODS: EQ-5D-5L US valuation data (n=1133) were analyzed. Respondents completed 15 TTO and 7 DCE tasks, each followed by three 5-level items rating difficulty: understanding the task, ability to differentiate between health state scenarios, and deciding on a preferred state/indifference point. Ordinal logistic regression models examined associations between difficulty items and age, gender, race, education, comorbidities, and health literacy (Brief Health Literacy Screener). Covariate-adjusted linear models explored within-person TTO-DCE differences in between-task difficulty.
RESULTS: Mean age was 48 years (SD: 14); 52% were female; 32% had inadequate/marginal health literacy. Difficulty understanding the task was reported by 3.8% (TTO) vs 1.5% (DCE); differentiating health states, 29.2% vs 4.0%; and deciding on a response, 88.2% vs 44.0%. TTO was more difficult than DCE across all three dimensions of difficulty (mean differences 0.22-1.29; effect size=0.29-0.81). Generally, older age, lower education, non-white race, and lower health literacy were associated with greater difficulty for both TTO and DCE tasks. DCE was relatively more difficult than TTO to understand for age 55+ (Beta -0.13, p=0.03), ref: age 18-34), and males (Beta -0.11, p=0.02).
CONCLUSIONS: Overall, TTO tended to be substantially more difficult than DCE for all 3 criteria related to task difficulty, although some sociodemographic factors increased or mitigated the magnitude of difference in perceived difficulty between tasks. Given the very limited explanatory power of the models, results suggest that socio-demographics have limited role in the perceived difficulty of the TTO and DCE as health valuation tasks.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE758
Topic
Economic Evaluation, Methodological & Statistical Research, Study Approaches
Disease
No Additional Disease & Conditions/Specialized Treatment Areas