Paul Dolan

Bio: Paul Dolan is an academic researcher from London School of Economics and Political Science. The author has contributed to research in topics: Health care & Population. The author has an hindex of 67, co-authored 231 publications receiving 21673 citations. Previous affiliations of Paul Dolan include University of Oslo & Princeton University.

Modeling Valuations for EuroQol Health States

Abstract: OBJECTIVES. It has become increasingly common for preference-based measures of health-related quality of life to be used in the evaluation of different health-care interventions. For one such measure, The EuroQol, designed to be used for these purposes, it was necessary to derive a single index value for each of the 243 health states it generates. The problem was that it was virtually impossible to generate direct valuations for all of these states, and thus it was necessary to find a procedure that allows the valuations of all EuroQol states to be interpolated from direct valuations on a subset of these. METHODS. In a recent study, direct valuations were elicited for 42 EuroQol health states (using the time trade-off method) from a representative sample of the UK population. This article reports on the methodology that was adopted to build up a "tariff" of EuroQol values from this data. RESULTS. A parsimonious model that fits the data well was defined as one in which valuations were explained in terms of the level of severity associated with each dimension, an intercept associated with any move away from full health, and a term that picked up whether any dimension in the state was at its most severe level. CONCLUSIONS. The model presented in this article appears to predict the values of the states for which there are direct observations and, thus, can be used to interpolate values for the states for which no direct observations exist.

Variations in population health status: results from a United Kingdom national questionnaire survey.

Abstract: Objective: To measure the health of a representative sample of the population of the United Kingdom by using the EuroQoL EQ-5D questionnaire. Design: Stratified random sample representative of the general population aged 18 and over and living in the community. Setting: United Kingdom. Subjects: 3395 people resident in the United Kingdom. Main outcome measures: Average values for mobility, self care, usual activities, pain or discomfort, and anxiety or depression. Results: One in three respondents reported problems with pain or discomfort. There were differences in the perception of health according to the respondent9s age, social class, education, housing tenure, economic position, and smoking behaviour. Conclusions: The EQ-5D questionnaire is a practical way of measuring the health of a population and of detecting differences in subgroups of the population. Key messages Measurement of health outcome requires the observation of states of health Patients9 involvement in recording and assessing their own state of health is a major element in the process of evaluating the impact of health care The EuroQoL EQ-5D questionnaire highlights variations in states of health which are consistent with previously published results High degrees of pain are reported in the general population. A category for pain is absent and thus undetected in the survey of disability by the Office of Population Censuses and Surveys

The time trade-off method: results from a general population study.

Abstract: An important consideration when establishing priorities in health care is the likely effects that alternative allocations of resources will have on health-related quality-of-life (HRQoL). This paper reports on a large-scale national study that elicited the relative valuations attached by the general public to different states of health (defined in HRQoL terms). Health state valuations were derived using the time trade-off (TTO) method. The data from 3395 respondents were highly consistent, suggesting that it is feasible to use the TTO method to elicit valuations from the general public. The paper shows that valuations for severe health states appear to be affected by the age and the sex of the respondent; those aged 18-59 have higher valuations than those aged 60 or over and men have higher valuations than women. These results contradict those reported elsewhere and suggest that the small samples used in other studies may be concealing real differences that exist between population sub-groups. This has important implications for public policy decisions.

A social tariff for EuroQol: results from a UK general population survey

Abstract: An important consideration when establishing priorities in health care is the likely effects that alternative allocations of resources will have on health-related quality of life (HRQoL). This paper reports on the analysis of data from a study which elicited health state valuations (using the time trade-off (TTO) method) from a representative sample of the UK health population. Health states were defined in terms of the EuroQol Descriptive System which generates 243 theoretically possible states. Because it was impossible to generate direct valuations for all of these states, it was necessary to find a procedure that allowed interpolation of valuations for all EuroQol states from direct valuations on a subset of these. This paper describes (in as non-technical manner as possible) the modelling technique used to generate a set of EuroQol valuations from directly observed valuations on 45 states. The specification of the models tested was derived from the ordinal nature of the EuroQol descriptive system, in which the value assigned to a particular state depends on the level of each dimension. Data were analysed at the individual level using a generalised least squares regression technique. A model that fitted the data well and that was readily interpretable was one in which valuations were explained in terms of three different elements: 1) the level of severity associated with each dimension independently of the levels of the other dimensions; 2) an intercept associated with any move away from full health; and 3) a term which identified whether any dimension was at its most severe level. The coefficients on these variables can be used to build up a fill ‘tariff’ of EuroQol values representing the views of a representative sample of the UK adult population. This social tariff has a number of potential uses, including the measurement of the likely impact on health status of different health care programmes or policies.

Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

Abstract: This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure. EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument's sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions. Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording 'slight-moderate-severe' problems, with anchors of 'no problems' and 'unable to do' in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states. A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.

Time Discounting and Time Preference: A Critical Review

Abstract: This paper discusses the discounted utility (DU) model: its historical development, underlying assumptions, and "anomalies" - the empirical regularities that are inconsistent with its theoretical predictions. We then summarize the alternate theoretical formulations that have been advanced to address these anomalies. We also review three decades of empirical research on intertemporal choice, and discuss reasons for the spectacular variation in implicit discount rates across studies. Throughout the paper, we stress the importance of distinguishing time preference, per se, from many other considerations that also influence intertemporal choices.

Report by the commission on the measurement of economic performance and social progress

Abstract: As GDP is a measure of market capacity and not economic well-being, this report has been commissioned to more accurately understand the social progress indicators of any given state. Gross domestic product (GDP) is the most widely used measure of economic activity. There are international standards for its calculation, and much thought has gone into its statistical and conceptual bases. But GDP mainly measures market production, though it has often been treated as if it were a measure of economic well-being. Conflating the two can lead to misleading indications about how well-off people are and entail the wrong policy decisions. One reason why money measures of economic performance and living standards have come to play such an important role in our societies is that the monetary valuation of goods and services makes it easy to add up quantities of a very different nature. When we know the prices of apple juice and DVD players, we can add up their values and make statements about production and consumption in a single figure. But market prices are more than an accounting device. Economic theory tells us that when markets are functioning properly, the ratio of one market price to another is reflective of the relative appreciation of the two products by those who purchase them. Moreover, GDP captures all final goods in the economy, whether they are consumed by households, firms or government. Valuing them with their prices would thus seem to be a good way of capturing, in a single number, how well-off society is at a particular moment. Furthermore, keeping prices unchanged while observing how quantities of goods and services that enter GDP move over time would seem like a reasonable way of making a statement about how society’s living standards are evolving in real terms. As it turns out, things are more complicated. First, prices may not exist for some goods and services (if for instance government provides free health insurance or if households are engaged in child care), raising the question of how these services should be valued. Second, even where there are market prices, they may deviate from society’s underlying valuation. In particular, when the consumption or production of particular products affects society as a whole, the price that individuals pay for those products will differ from their value to society at large. Environmental damage caused by production or consumption activities that is not reflected in market prices is a well-known example.