Published online November 1, 2004
PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1375 (doi:10.1542/peds.2004-1283)
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Comments on the Prosser et al Approach to Value Disease Reduction in Children

Philippe Beutels, PhD
University of Sydney and Royal Alexandra Hospital for Children
National Centre for Immunisation Research and Surveillance
Westmead, New South Wales 2145, Australia
University of Technology, Sydney
Centre for Health Economics Research and Evaluation
Sydney, New South Wales 2007, Australia

Rosalie C. Viney, MEc
University of Technology, Sydney
Centre for Health Economics Research and Evaluation
Sydney, New South Wales 2007, Australia

To the Editor.

Prosser et al1 quantify the benefits of childhood disease prevention by a novel approach. Adults were asked to consider their own time spent caring for their child, as well as the time that the child would spend suffering in the undesirable health state, and trade it off with any amount of their own life.

Valuing health states by a standard time trade-off (TTO) method requires an experimental design that is explicit about health-state durations and what follows them (eg, death or full health) and a theoretical framework that is clear about the nature of the respondent's utility function and how others' well-being enters it. The experimental design of Prosser et al ignores these, thus their TTO results could only provide an ordinal ranking and should not be used to estimate the value of quality of life (QOL).*2 Guilt and interview biases would be reduced by asking respondents to trade off the child's time for the child's QOL only, which would be more consistent with theory and increase comparability and interpretability.

Furthermore, even if the responses are assumed valid for QOL measurement, Prosser et al seem to produce gross overestimates. They state that a willingness to trade off 7 days to prevent simple otitis media equates to a 1-time loss of 0.02 quality-adjusted life-years (QALYs). Given that the average respondent could reasonably expect to survive for another 30 years, forgoing 7 days equates to 0.00064 QALYs. This error may explain why the costs per QALY gained are less than one 20th of the costs per life-year gained, a difference that is extremely large.*

Finally, Prosser et al are stuck with an interpretation problem related to time preference, because they did not specify which part of their lives respondents were meant to trade off, and the various implicit time preferences cannot be disentangled because of the different types of trade-offs required within and between different lives.3

Therefore, the modified TTO task seems to introduce more problems than it solves, and the QALY results are invalid.

The interpretation of their alternative willingness-to-pay approach is not straightforward. In the parent sample, the median willingness to pay for the vaccine, which specified all risk reductions together, was $250 but was much higher for the same risk reduction for specific health states on their own (eg, $500 for meningitis). Their cost-benefit analysis lacks transparency regarding how (and which of) these values were used.

FOOTNOTES

* See the extended version of this letter submitted to the P3R section of Pediatrics online (available at: www.pediatrics.org/cgi/eletters/113/2/283). Back

REFERENCES

  1. Prosser LA, Ray GT, O'Brien M, Kleinman K, Santoli J, Lieu TA. Preferences and willingness to pay for health states prevented by pneumococcal conjugate vaccine. Pediatrics. 2004;113 :283 –290[Abstract/Free Full Text]
  2. Drummond M, O'Brien B, Stoddart G, Torrance G. Methods for the Economic Evaluation of Health Care Programmes. 2nd ed. Oxford, United Kingdom: Oxford University Press; 1997
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics

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Comments on the Prosser et al Approach to Value Disease Reduction in Children: In Reply
Lisa A. Prosser and Tracy A. Lieu
Pediatrics 2004 114: 1375-1376. [Extract] [Full Text]  




This Article
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