OBJECTIVES: The discrete choice experiment(DCE) is utilized in the EQ-5D valuation protocol, which required participants to elicit preferences between hypothetical health states. However, complains were often received as many respondents find the health states presented in the trade-off task unrealistic and difficult to compare. Besides the conventional DCE, an innovative approach Analytical Hierarchy Process(AHP) may allow the respondents to rate the EQ-5D dimensions and levels directly. While comparisons between the AHP and DCE are common in decision-making research, such comparison has not been conducted in EQ-5D health state preferences to our knowledge. The project targeted to conduct a head-on comparison between DCE and AHP in EQ-5D-5L health state preference elicitation.

METHODS: A cross-sectional survey was collected in person or via online Zoom meeting in Hong Kong SAR, and participants who aged ≥18 and with Chinese literacy were eligible for the study. Each respondent answered 15 AHP and 14 DCE tasks before collecting their demographics.

RESULTS: Between July 2022 and March 2023, 368 cases were recruited. Concerning the ease of understanding the trade-off tasks, 51.4% of participants (n=189) preferred AHP to DCE and 37.0% (n=136) reported vice versa. The relative weighting of EQ-5D dimensions derived from AHP topped at 0.285 by Self-care, followed by Mobility(0.226), Usual Activities(0.187), Pain/Discomfort(0.175) and Anxiety/Depression(0.126). An identical order was reported by participants’ direct ranking exercise. Expanding the comparison to EQ-5D-5L, the Pearson Correlation coefficient and Spearman Rank Correlation coefficient between the utility levels derived from AHP and DCE were 0.816 and 0.880 respectively, hinting a strong agreement and monotonic relationship between the two health state preference elicitation methods.

CONCLUSIONS: AHP had demonstrated its ability to report comparable findings to both patient-reported ranking and DCE-derived outcome. As participants often find AHP easier to understand, AHP could be an alternative with lower cognitive burden and applicable to cognitive-impaired community in preference elicitations.