Is there a case for using visual analogue scale valuations in cost-utility analysis?
Is there a case for using visual analogue scale valuations in cost-utility analysis?
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DOI：
10.1002/hec.1086
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发表时间：
2006-07-01
期刊：
影响因子：
2.1
通讯作者：
Devlin, Nancy
中科院分区：
文献类型：
--
作者：
Parkin, David;Devlin, Nancy
本文批判性地回顾了有关健康状态视觉模拟量表（VAS）评估及其在成本效用分析（CUA）中的应用的理论和实证命题。经济评估文献中广泛重复的一个论断是，从理论上讲，VAS 估值的劣势。常见的五点批评是：VAS缺乏理论基础； VAS 值并非“基于选择”； VAS值与效用不确定性要求不一致； VAS 估值数据中观察到的背景和范围效应意味着它们甚至不能被视为代表可衡量的价值函数；当完成VAS时，人们并不是试图表达价值观。我们解决了每一点：VAS确实有理论基础，与QALY和CUA的非福利主义基础完全一致； VAS 的“无选择”性质是根据与货币而非健康状态评估相关的既定偏好标准来错误判断的，并且 VAS 评估在任何情况下都涉及选择因素；由于评估的目的是用于社会决策，因此在确定性条件下得出 VAS 值可能是有利的；尽管VAS存在测量问题，但更好的设计和数据转换等手段可以解决这些问题；对于任何引出价值的方法，期望人们有意识地根据效用等社会科学结构进行思考是不现实的。此外，替代方法还存在理论和经验方面的问题。选择合适的估值方法应基于经验表现，在这方面VAS具有重要的优势。我们的结论是，有充分的理由对反对 VAS 的共识观点提出质疑，并挑战那些持有该观点的人提出更有说服力的论据和证据来支持替代方法。然而，我们确定了需要进一步研究的领域，以建立和巩固 VAS 作为估值方法的潜力。版权所有 (c) 2006 John Wiley & Sons, Ltd.
This paper critically reviews theoretical and empirical propositions regarding visual analogue scale (VAS) valuations of health states and their use in cost-utility analysis (CUA). A widely repeated assertion in the economic evaluation literature is the inferiority, on theoretical grounds, of VAS valuations. Five common criticisms are: VAS lacks a theoretical foundation; VAS values are not 'choice based'; VAS values are not consistent with utility-under-uncertainty requirements; context and range effects observed in VAS valuation data mean that they cannot even be considered to represent measurable value functions; and when completing a VAS, people are not trying to express values.We address each of these points: the VAS does have a theoretical basis, being entirely consistent with the non-welfarist foundations of QALYs and CUA; the 'choiceless' nature of the VAS is incorrectly judged by stated preference criteria relevant to monetary rather than health state valuations, and VAS valuations do in any case involve an element of choice; because valuations are intended for use in social decision-making, it may be advantageous that VAS values are elicited under conditions of certainty; although there are measurement problems with the VAS, means such as better design and transformations of data can deal with these; and with any method of eliciting values, it is unrealistic to expect people consciously to think in terms of social science constructs such as utilities.Moreover, there are problems, both theoretical and empirical, with alternative methods. Selection of the appropriate valuation method should be based on empirical performance, and in this the VAS has important advantages. We conclude that there are strong grounds for disputing the consensus view against the VAS and challenge those who hold it to deploy more convincing arguments and evidence in favour of alternative methods. However, we identify areas where further research is required to establish and consolidate the potential of the VAS as a valuation method. Copyright (c) 2006 John Wiley & Sons, Ltd.