PubMed · 11057982
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A D Spigelman. Does more equal less or does less equal more?. https://doi.org/10.1046/j.1440-1762.2000.00374.x
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We test a chained time trade-off (TTO) approach to estimating health gains from interventions by asking respondents to directly compare the "before" and "after" intervention health states in the TTO framework. Respondents with experience of both health states were used, thus minimising biases stemming from confusion surrounding health descriptions. We found that responses to these direct comparisons were much more likely to capture a perceived change in health status than the conventional approach to TTO estimation. This is an important finding because the TTO method is preferred by practitioners to many other direct generic methods of health status valuation both on empirical grounds and because it is based on the notion of opportunity cost, which is central to consumer theory, requiring respondents to express their preferences in terms of foregoing some of one good in exchange for more of another (unlike a rating scale).
The field of health status and quality of life (QoL) measurement - as a formal discipline with a cohesive theoretical framework, accepted methods, and diverse applications--has been evolving for the better part of 30 years. To identify health status and QoL instruments and review them against rigorous criteria as a precursor to creating an instrument library for later dissemination, the Medical Outcomes Trust in 1994 created an independently functioning Scientific Advisory Committee (SAC). In the mid-1990s, the SAC defined a set of attributes and criteria to carry out instrument assessments; 5 years later, it updated and revised these materials to take account of the expanding theories and technologies upon which such instruments were being developed. This paper offers the SAC's current conceptualization of eight key attributes of health status and QoL instruments (i.e., conceptual and measurement model; reliability; validity; responsiveness; interpretability; respondent and administrative burden; alternate forms; and cultural and language adaptations) and the criteria by which instruments would be reviewed on each of those attributes. These are suggested guidelines for the field to consider and debate; as measurement techniques become both more familiar and more sophisticated, we expect that experts will wish to update and refine these criteria accordingly.