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Objectives: In cost-effectiveness analysis of health technologies, health state utilities are needed. They are often elicited with acomposite time trade-off (cTTO) method, particularly for the widely used EQ-5D-5L. Unfortunately, cTTO discriminatorypower is hindered by (1) respondents’ nontrading (NT) of time for quality, (2) censoring of utilities at 21, and (3) poorcorrelation of negative utilities with state severity. We investigated whether modifying cTTO can mitigate these effects.Methods: We interviewed online 478 students (February to April, 2021) who each valued the same 10 EQ-5D-5L health statesin 1 of 3 arms. Arm A used a standard cTTO, expanded with 2 questions to explore reasons for NT and censoring. Arms B and Cused a time trade-off with modified alternatives offered to overcome loss aversion, to unify the tasks for positive and negativeutilities, and to enable eliciting utilities , 21.Results: In arms B and C, we observed less NT than in A (respectively, 4% and 4% vs 10%), more strictly negative utilities (38%and 40% vs 25%), and more utilities # 21 (18% and 30% vs 10%). The average utility of state 55555 dropped to 22.15 and 22.52from 20.53. Enabling finer trades in arm A reduced NT by 70%. Arms B and C yielded an intuitive association betweennegative utilities and state severity. These arms were considered more difficult and resulted in more inconsistencies.Conclusions: The discriminatory power of cTTO can be improved, but it may require increasing the difficulty of the task. Thestandard cTTO may overestimate the utilities, especially of severe states. |
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