Using Time Trade-Off Methods to Assess Preferences Over Health Care Delivery Options: A Feasibility Study

Objectives: Time trade-off (TTO) methods are often used for utility assessments of different health states to measure quality of life (QOL). They have not generally been used to assess social preferences with respect to options for health care delivery, although the need for quantifying these preferences is arguably just as important. Policy makers are increasingly faced with decisions about how much to invest in, and how much to incentivize, particular modes of health care delivery, generally with little evidence about user preferences. Methods: This study draws on long-term care (LTC) delivery modes as an example. Focus groups were conducted to approach this issue both qualitatively and quantitatively. In a qualitative pilot study, two focus groups discussed issues of the LTC decision-making process and preferences among different LTC options. The TTO was then used to assess QOL for each LTC option, conditional on a specific health state, and then quantified user's LTC preferences by differential QOL between the two options. Results: This study found that the TTO-elicited utilities and their differences are consistent with the LTC preferences revealed from focus group discussions. These preferences depend on levels of disability and education. Conclusions: The modified TTO technique seems a feasible method to quantify preferences over LTC delivery options. These methods may be applicable to various health care alternatives in which better evidence is needed to guide funding policy.