Preferences for EQ-5D health states and experienced health states in the US general population: The impact of framing and current health on values

Introduction: There is debate in the research community over whose preferences to use in cost-effectiveness analysis (CEA)- those of individuals experiencing health states of interest or those of the general public. This work examines the impact of the scope of EQ-5D health state descriptions on elicited health state values. This work also examines the impact of current health on preferences for EQ-5D health states and the impact of changes in health on changes in health state preferences.;Methods: Cross-sectional data from the US Valuation of the EQ-5D (USVEQ) study was used along with data from the Medical Expenditure Panel Survey (MEPS) (2001-2002). USVEQ data were used to assess: 1) differences in preferences for experienced health states and EQ-5D health state descriptions; and 2) the impact of current health on preferences. MEPS data were used to examine changes in preferences over time.;Results: Analysis of USVEQ data indicates that there are differences in preferences for experienced health and EQ-5D health states. Moreover, this analysis indicates that current health has no consistent impact on preferences for EQ-5D health states. Lastly, changes in health over time have an impact on preferences. Improvements and declines in health are not valued similarly, though findings are not consistent with Prospect Theory.;Conclusion: There appear to be issues of scope in how EQ-5D health state descriptions represent real-life, experienced heath states. This raises concerns with the US societal index scoring systems and its ability to accurately represent preferences that individuals may have for the respective health states that they are actually experiencing. These analyses, however, did not find that current health has a consistent affect on preferences for EQ-5D health state, which suggests that societal scoring algorithms do not need to take the health of survey respondents into consideration. Lastly, additional research is needed to assess the impact of coping and adaptation on health state preferences and changes in preferences over time.