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1.  One-to-one versus group setting for conducting computer-assisted TTO studies: findings from pilot studies in England and the Netherlands 
We compare two settings for administering time trade-off (TTO) tasks in computer-assisted interviews (one-to-one, interviewer-led versus group, self-complete) by examining the quality of the data generated in pilot studies undertaken in England and the Netherlands. The two studies used near-identical methods, except that in England, data were collected in one-to-one interviews with substantial amounts of interviewer assistance, whereas in the Netherlands, the computer aid was used as a self-completion tool in group interviews with lesser amounts of interviewer assistance. In total, 801 members of the general public (403 in England; 398 in the Netherlands) each completed five TTO valuations of EQ-5D-5L health states. Respondents in the Netherlands study showed a greater tendency to give ‘round number’ values such as 0 and 1 and to complete tasks using a minimal number of iterative steps. They also showed a greater tendency to skip the animated instructions that preceded the first task and to take into account assumptions that they were specifically asked not to take into account. When faced with a pair of health states in which one state dominated the other, respondents in the Netherlands study were more likely than those in the England study to give a higher value to the dominant health state. On the basis of these comparisons, we conclude that the one-to-one, interviewer-led setting is superior to the group, self-complete setting in terms of the quality of data generated and that the former is more suitable than the latter for TTO studies being used to value EQ-5D-5L.
doi:10.1007/s10198-013-0509-9
PMCID: PMC3728432  PMID: 23900666
Time trade-off; Mode of administration; Preference elicitation; EQ-5D; Interviewer effect; I100
2.  Time to tweak the TTO: results from a comparison of alternative specifications of the TTO 
This article examines the effect that different specifications of the time trade-off (TTO) valuation task may have on values for EQ-5D-5L health states. The new variants of the TTO, namely lead-time TTO and lag-time TTO, along with the classic approach to TTO were compared using two durations for the health states (15 and 20 years). The study tested whether these methods yield comparable health-state values. TTO tasks were administered online. It was found that lag-time TTO produced lower values than lead-time TTO and that the difference was larger in the longer time frame. Classic TTO values most resembled those of the lag-time TTO in a 20-year time frame in terms of mean absolute difference. The relative importance of different domains of health was systematically affected by the duration of the health state. In the tasks with a 10-year health-state duration, anxiety/depression had the largest negative impact on health-state values; in the tasks with a 5-year duration, the pain/discomfort domain had the largest negative impact.
doi:10.1007/s10198-013-0507-y
PMCID: PMC3728436  PMID: 23900664
Time trade-off; Lead-time TTO; Lag-time TTO; Utility; Health-state preferences; I10
3.  Lead versus lag-time trade-off variants: does it make any difference? 
Abstract
Objectives
The traditional time trade-off (TTO) method has some problems in the valuation of health states considered worse than dead. The aim of our study is to compare two TTO variants that address this issue: lead-time and lag-time TTO.
Methods
Quota sampling was undertaken in June 2011 in Buenos Aires as part of the EQ-5D-5L Multinational Pilot Study. Respondents were randomly assigned to one of the TTO variants with two blocks of five EQ-5D-5L health states. Tasks were administered using a web-based digital aid (EQ-VT) administered in a group interview.
Results
A total of 387 participants were included [mean age 38.85 (SD: 13.97); 53.14 % females]. The mean observed values ranged from 0.44 (0.59) for state 21111 to 0.02 (0.76) for state 53555 in the lead-time group and between 0.53 (0.52) and 0.08 (0.76) in the lag-time group. There were no statistically significant differences in the values between TTO variants, except for a significant difference of 0.19 for state 33133. In both variants, marked peaks were observed around the value 0 across all states, with a higher percentage of 0 responses in the last state valued, suggesting ordering effects.
Conclusions
No important differences were found between TTO variants regarding values for EQ-5D-5L health states, suggesting that they could be equivalent variants. However, differences between the two methods may have been obscured by other aspects of the study design affecting the characteristics of the data.
doi:10.1007/s10198-013-0505-0
PMCID: PMC3728455  PMID: 23900662
Time trade-off; Lead-time TTO; Lag-time TTO; Worse than dead; EQ-5D-5L; Quality of life; I10; C93; D01
4.  Introducing the composite time trade-off: a test of feasibility and face validity 
Introduction
This study was designed to test the feasibility and face validity of the composite time trade-off (composite TTO), a new approach to TTO allowing for a more consistent elicitation of negative health state values.
Methods
The new instrument combines a conventional TTO to elicit values for states regarded better than dead and a lead-time TTO for states worse than dead.
Results
A total of 121 participants completed the composite TTO for ten EQ-5D-5L health states. Mean values ranged from −0.104 for health state 53555 to 0.946 for 21111. The instructions were clear to 98 % of the respondents, and 95 % found the task easy to understand, indicating feasibility. Further, the average number of steps taken in the iteration procedure to achieve the point of indifference in the TTO and the average duration of each task were indicative of a deliberate cognitive process.
Conclusion
Face validity was confirmed by the high mean values for the mild health states (>0.90) and low mean values for the severe states (<0.42). In conclusion, this study demonstrates the feasibility and face validity of the composite TTO in a face-to-face standardized computer-assisted interview setting.
doi:10.1007/s10198-013-0503-2
PMCID: PMC3728457  PMID: 21796438
Time trade-off; Health state values; EQ-5D; Health-related quality of life; I10; I19

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