Value in Health最新文献

{"title":"SHOULD EARLY-STAGE NIH FUNDING INFLUENCE PHARMACEUTICAL DRUG PRICING?","authors":"William V Padula, R Brett McQueen","doi":"10.1016/j.jval.2025.09.3065","DOIUrl":"https://doi.org/10.1016/j.jval.2025.09.3065","url":null,"abstract":"<p><strong>Objectives: </strong>To assess whether early-stage funding from the National Institutes of Health (NIH) should influence pharmaceutical pricing policy, particularly in the context of recent federal proposals linking public research support to drug affordability mandates.</p><p><strong>Methods: </strong>We conducted a targeted literature review of peer-reviewed publications, government reports, and policy documents. This was supplemented by discussions with former NIH leadership to understand the rationale behind NIH's role in drug development and pricing policy. The review prioritized conceptual breadth over comprehensiveness. These data were then used to inform a policy analysis evaluating the implications of NIH-related pricing interventions on innovation incentives and public-private collaboration.</p><p><strong>Results: </strong>Our analysis reveals that while NIH plays a crucial role in early-stage research, private industry contributes the majority of investment, risk, and infrastructure required to bring medicines to market. Policies such as the Bayh-Dole Act and related technology transfer frameworks were designed to leverage private sector capabilities, not to enforce pricing controls. Economic studies indicate that the societal surplus from drug innovation overwhelmingly benefits patients, with manufacturers capturing only a small share of total value. Historical experience with government-imposed \"reasonable pricing\" clauses discouraged collaboration and was ultimately repealed. Recent proposals to revive such clauses or allow price-based march-in rights may deter private investment and undermine innovation.</p><p><strong>Conclusions: </strong>Drug prices should reflect value-based assessments and incentives for future innovation, not be adjusted retrospectively based on NIH involvement. Efforts linking pricing to public funding risk distorting the public-private partnership that has made the U.S. the global leader in biomedical innovation.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EQ-5D-5L in Multiple Sclerosis: Estimated Utility Values, Minimal (Clinically) Important Changes, and Direct and Indirect Influences Over Time.","authors":"Carolyn A Young, Roger J Mills, Alan Tennant","doi":"10.1016/j.jval.2025.07.019","DOIUrl":"10.1016/j.jval.2025.07.019","url":null,"abstract":"<p><strong>Objectives: </strong>In multiple sclerosis (MS), studies reporting mean EQ-5D-5L health utility values ranged from 0.31 to 0.82, and a 2024 systematic review found no published anchor-based estimates for EQ-5D-5L minimal important change (MIC). We derived age-sex-specific utility reference values and MIC of the EQ-5D-5L in a large UK sample with MS.</p><p><strong>Methods: </strong>The Trajectories of Outcomes in Neurological Conditions-MS study calculated EQ-5D-5L age-sex and disability subtype-specific utility estimates. Multiple regression identified possible predictors of health status for inclusion into a structural equation model. Calculation of MIC used an anchor-based method.</p><p><strong>Results: </strong>Among 5509 participants, aged 17 to 87, females (73.7%), the mean EQ-5D-5L utility was 0.682 (95% CI: 0.675-0.688; range -0.28-1.0). There was an age gradient and difference between male and female utilities across each age group (age: F 34.3 (df 11, 497): P < .001; sex: t 5.794; (df 5507): P < .001). In structural equation model, higher self-efficacy improved EQ-5D-5L, whereas cognitive problems, progressive disease, fatigue, bladder problems, and stigma decreased EQ-5D-5L. In the longitudinal sample comprising 2066 people with MS, mean utility value at follow-up was 0.673 (95% CI: 0.662-0.683) and MIC was 0.146 (95% CI: 0.137-0.154). MIC varied significantly by MS subtype and for those reporting a relapse within the past year.</p><p><strong>Conclusions: </strong>Health utility values for MS were consistently lower than those found in the English population and were influenced by factors amenable to clinical intervention. Anchor-based MIC varied by subtype and relapse history, showing that when assessing the significance of changing health status from the perspective of those with MS, a uniform MIC should not be used.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric properties of cognition bolt-ons for the EQ-5D-3L and EQ-5D-5L: a systematic review.","authors":"Fanni Rencz, Stevanus Pangestu, Brendan Mulhern, Aureliano Paolo Finch, Mathieu F Janssen","doi":"10.1016/j.jval.2025.09.3053","DOIUrl":"https://doi.org/10.1016/j.jval.2025.09.3053","url":null,"abstract":"<p><strong>Objectives: </strong>Cognition is the most commonly used EQ-5D bolt-on, with many different versions varying by descriptors and response levels (3L vs. 5L). We aimed to systematically review the psychometric properties of cognition bolt-ons for the EQ-5D-3L and EQ-5D-5L.</p><p><strong>Methods: </strong>A systematic review was conducted in PubMed, Web of Science and Google Scholar following PRISMA 2020 guidelines (PROSPERO:CRD42023445567). We assessed the bolt-ons' performance both as individual items and when added to the EQ-5D. Each bolt-on version was rated as positive (+) or non-positive (-) within each publication using a checklist, and scores were summed across publications to reflect overall performance.</p><p><strong>Results: </strong>In total, 101 publications from 72 studies met the inclusion criteria, examining 15 three-level and 13 five-level bolt-ons. The most frequently reported psychometric properties were item-level ceiling (n=75) and known-groups validity (n=54). Fewer studies explored convergent or divergent validity (n=8 for each), responsiveness (n=3), patient-proxy agreement (n=2) and test-retest reliability (n=1). None reported on content validity. Five-level bolt-ons outperformed three-level bolt-ons in terms of overall performance (3L: 55+/57-; 5L: 45+/28-). Supportive psychometric evidence varied by populations, e.g. head/brain injury (3L: 11+/11-; 5L: 1+/3-) and dementia (3L: 9+/8-; 5L: 4+/4-). The most-tested bolt-ons were the Janssen 2013 (5L, cognition: 18+/15-) and Haagsma 2005 (3L, thinking ability: 8+/12-) versions, with fewer than 10 assessments for all other bolt-ons.</p><p><strong>Conclusion: </strong>Despite several publications, the psychometric evidence remains insufficient to identify a preferred cognition descriptor. Future research should prioritise content validity testing to inform the selection of candidate items, with quantitative psychometric evaluation preferably conducted afterward.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost per Opioid-Free Year: A Systematic Review and Summary Analysis","authors":"Babasoji E. Oyemakinde PhD ,&nbsp;Danielle Ryan MPH ,&nbsp;Techna Cadet MPH ,&nbsp;Tyler Judge MD ,&nbsp;Manesh Gopaldas MD ,&nbsp;Ali Jalali PhD ,&nbsp;Sean M. Murphy PhD","doi":"10.1016/j.jval.2025.07.008","DOIUrl":"10.1016/j.jval.2025.07.008","url":null,"abstract":"<div><h3>Objectives</h3><div>Opioids remain a leading cause of death in the United States, and time free from opioid use is a common measure of effectiveness in economic evaluations of opioid use disorder (OUD) interventions. This study reviews the economic evaluation literature on OUD, identifies studies that calculated incremental cost-effectiveness ratios (ICER) based on time free from opioids, and establishes a benchmark for comparison in future research.</div></div><div><h3>Methods</h3><div>The review examined economic evaluations of OUD interventions published in the peer-reviewed literature from inception to September 2024. ICERs of cost per period of opioid-free time were extracted or calculated from studies meeting the inclusion criteria. Monetary values were converted to 2024 USD and ICERs normalized to cost per opioid-free year (OfY). Articles were classified by intervention location (United States vs international) and economic perspective.</div></div><div><h3>Results</h3><div>Fourteen articles met the inclusion criteria: 8 from the United States, 4 from Australia, 1 from Malaysia, and 1 from the United Kingdom. Among the US-based studies, the average ICER per OfY for the healthcare-sector, the state policymaker, and the societal perspective were $243 053/OfY, $17 674/OfY, and $32 125/OfY, respectively. For international studies, average ICERs for the healthcare-sector and societal perspectives were $79 765/OfY and $195 980/OfY, respectively.</div></div><div><h3>Conclusions</h3><div>Cost per OfY is a widely used metric in economic evaluations because of its relative importance as a measure of clinical effectiveness. However, a universally accepted benchmark for decision making does not yet exist. This review aggregates data from existing studies that provided this measure, offering an initial step for establishing a cost-effectiveness threshold for cost per OfY.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 10","pages":"Pages 1461-1471"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the County-Level Social Deprivation Index 2020 and Its Association With Health Outcomes in China","authors":"Xiaoning He PhD ,&nbsp;Peisong Dong MA ,&nbsp;Yuhang Xin PhD ,&nbsp;Richard Cookson PhD ,&nbsp;Jing Wu PhD","doi":"10.1016/j.jval.2025.07.012","DOIUrl":"10.1016/j.jval.2025.07.012","url":null,"abstract":"<div><h3>Objective</h3><div>The lack of an up-to-date area deprivation index for China is a major barrier to health inequality monitoring and evaluation in the world’s most populous country. This study aimed to develop the County-Level Social Deprivation Index 2020 for China from the most recent census data and analyze its relation to health outcomes.</div></div><div><h3>Methods</h3><div>On the basis of the 2020 census data, 14 indicators for 2844 counties were selected across 5 domains, including income, employment, housing, education, and urban-rural location. The index was created using principal component analysis with oblique rotation. Associations between deprivation quintile groups and life expectancy and infant mortality were examined, with extensive sensitivity analyses around alternative indicators and weighting methods.</div></div><div><h3>Results</h3><div>The new deprivation index was based on a weighted sum of 3 components that altogether explained 74% of the variation in the 14 indicators. Counties in the Eastern region tended to be less deprived, whereas counties in the Southwestern region tended to be more deprived. The life expectancy was 4.51 years shorter, and the infant mortality was 5.18% higher for counties in the most deprived quintile than those in the least deprived quintile. The grouping result and the association with the health outcomes were consistent across the primary and sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>The County-Level Social Deprivation Index 2020 for China reveals a clear social gradient in life expectancy and infant mortality across deprivation quintile groups. It can be used to help monitor health inequalities, identify high-need populations and quantify health inequality impacts in China.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 10","pages":"Pages 1517-1525"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meaningful Score Differences and Meaningful Score Regions of the Patient-Reported Outcomes Measurement Information System® Pediatric Asthma Impact Scale","authors":"Jing Yuan PhD ,&nbsp;Li Lin MS ,&nbsp;Kevin Weinfurt PhD ,&nbsp;Nicole Lucas BS ,&nbsp;Allison J. Burbank MD ,&nbsp;Michelle L. Hernandez MD ,&nbsp;I-Chan Huang PhD ,&nbsp;Bryce B. Reeve PhD","doi":"10.1016/j.jval.2025.05.010","DOIUrl":"10.1016/j.jval.2025.05.010","url":null,"abstract":"<div><h3>Objectives</h3><div><span>To estimate meaningful score differences (MSDs) and meaningful score regions (MSRs) for the Patient-Reported Outcomes Measurement Information System</span><strong>®</strong> (PROMIS<strong>®</strong><span>) Pediatric Asthma Impact Scale to enhance score interpretability.</span></div></div><div><h3>Methods</h3><div>Secondary analysis included 106 children with asthma (8-17 years of age) who completed weekly surveys for 4 weeks. Repeated measures correlations examined the magnitude of association of the PROMIS Pediatric Asthma Impact Scale with other asthma measures. MSDs were calculated using mixed models with the Global Impact of Change (GIC) on Asthma and Health scores as anchors. MSRs were calculated using the receiver operating characteristics analysis with Self-Reported Asthma Symptom Rating (ASR), Global Initiative for Asthma (GINA) control criteria, and Asthma Control Test (ACT) or Childhood Asthma Control Test (cACT) as anchors.</div></div><div><h3>Results</h3><div>Changes in PROMIS Pediatric Asthma Impact T-scores were correlated with GIC-Asthma (r = 0.45) and GIC-Health (r = 0.34). MSDs were 2.3 to 2.5 points for improvement and 3.5 to 3.6 points for deterioration. PROMIS Pediatric Asthma Impact T-scores were correlated with GINA (r = −0.22), ACT (r = −0.42), cACT (r = −0.41), and ASR (r = −0.47). The MSR cutoff T-scores for GINA were 38.7 and 49.2 between controlled, partly controlled, and uncontrolled asthma; for ACT/cACT, 45.6 between controlled and uncontrolled; and for ASR, 47.9, 50.1, and 55.8 between very good, good, a little good, and bad.</div></div><div><h3>Conclusions</h3><div><span>Following recommendations from the US Food and Drug Administration’s patient-focused drug development guidance on clinical outcome assessments, estimated MSDs and MSRs aid the interpretation of scores and changes in scores observed in </span>clinical research studies to reflect the meaningful impact of asthma on children.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 10","pages":"Pages 1540-1547"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achieving Patient-Centered Value/Health Technology Assessment: Recommendations From a Multistakeholder eDelphi Panel","authors":"Julia F. Slejko PhD ,&nbsp;Tara A. Lavelle PhD ,&nbsp;Joe Vandigo PhD ,&nbsp;Omar A. Escontrías DrPH, MPH ,&nbsp;Silke C. Schoch MA ,&nbsp;Elisabeth M. Oehrlein PhD","doi":"10.1016/j.jval.2025.06.014","DOIUrl":"10.1016/j.jval.2025.06.014","url":null,"abstract":"<div><h3>Objectives</h3><div>Current methodological guidelines for value/health technology assessment (V/HTA) and cost-effectiveness analysis describe traditional approaches not originally created to be patient centered. The objective of this study was to identify opportunities for guidance and develop a set of consensus recommendations on methods and needs for patient-centered V/HTA, including identifying and collecting data inputs, results reporting, and future priority topics.</div></div><div><h3>Methods</h3><div>This study included multiple phases: (1) listening sessions with 10 patient group representatives to elicit priorities for patient-centered data elements for V/HTA; (2) leverage findings from step 1 to inform qualitative interviews with 10 health economists to guide the development of an eDelphi instrument; and (3) use the findings from step 1 and 2 to conduct an eDelphi exercise with multistakeholder participants to develop consensus recommendations that guide patient-centered V/HTA.</div></div><div><h3>Results</h3><div>After 2 Delphi rounds, 28 statements achieved consensus (≥80% agreement); 2 statements did not achieve consensus (&lt;80% agreement). The recommendations included a need for data that more broadly reflect the impacts, both inside and outside the healthcare sector, relevant to patients and more accurately reflect the real-world natural history of disease. There was consensus on the need for patient input throughout the assessment process, including plain-language reporting that improves inclusion of patient audiences.</div></div><div><h3>Conclusions</h3><div>Multistakeholder consensus on the recommendations presented serve as a basis for future work toward progressing patient-centered V/HTA.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 10","pages":"Pages 1472-1480"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Aversion to Income-Related Health Inequality in Canada: An Equity-Efficiency Trade-Off Experiment","authors":"Nicolas Iragorri MSc ,&nbsp;Shehzad Ali MBBS, PhD ,&nbsp;Sharmistha Mishra MD ,&nbsp;Beate H. Sander PhD","doi":"10.1016/j.jval.2025.06.021","DOIUrl":"10.1016/j.jval.2025.06.021","url":null,"abstract":"<div><h3>Objectives</h3><div>To estimate the extent to which people living in Canada are averse to income-related health inequalities, a critical component for equity-informative economic evaluations but lacking in the Canadian context.</div></div><div><h3>Methods</h3><div>We conducted 3 experiments among a sample of adults living in Canada to elicit value judgements about reducing income-related health inequality versus improving population health. Each experiment compared 2 programs: (experiment 1) universal and tailored vaccination, (experiment 2) nonspecific prevention programs, and (experiment 3) generic healthcare programs. The programs varied in terms of efficiency (additional life-years), and health inequality across income groups. Preferences were elicited using benefit trade-off analysis and were classified as follows: pro-rich (maximizing the health of individuals with the highest income), health maximizer (maximizing total health), weighted prioritarian (willing to trade some health to reduce inequalities), maximin (only improving the health of the individuals with the lowest income), and egalitarian (minimizing health inequalities at all costs).</div></div><div><h3>Results</h3><div>We recruited 1000 participants per experiment. Preferences for the vaccination, prevention, and generic experiments were distributed as follows: pro-rich (aversion parameter &lt;0): 31%, 22%, and 16%, respectively; health maximizers (aversion parameter = 0): 2%, 3%, and 2%, respectively; weighted prioritarians (aversion parameter &gt; 0): 13%, 19%, and 22%, respectively; maximins (aversion parameter = ∞): 0%, 1%, and 3%, respectively; and egalitarian (aversion parameter undefined): 54%, 55%, and 57%, respectively. The median responses reflected a preference for minimizing income-related health inequalities across the 3 experiments.</div></div><div><h3>Conclusions</h3><div>Our findings suggest a strong aversion to income-related health inequality among the respondents with more than half being classified as egalitarians.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 10","pages":"Pages 1548-1557"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Price Benchmarks and Comparative Clinical Effectiveness to Predict Initial Price Offers for Medicare Drug Price Negotiation (Initial Price Applicability Year 2027).","authors":"Kevin H Li, Emma M Cousin, Nico Gabriel, Sean D Sullivan","doi":"10.1016/j.jval.2025.09.3054","DOIUrl":"10.1016/j.jval.2025.09.3054","url":null,"abstract":"<p><strong>Objectives: </strong>This study estimated initial price offers for the 15 drugs selected for the Medicare Drug Price Negotiation Program in the Initial Price Applicability Year 2027.</p><p><strong>Methods: </strong>We applied the Centers for Medicare and Medicaid Services guidance to construct a list of therapeutic alternatives for each drug. Price benchmarks included the statutory discount, Big 4/Federal Supply Schedule prices, estimated Medicare Part D net prices, and wholesale acquisition cost. Comparative effectiveness evidence was extracted from peer-reviewed network meta-analyses, clinical guidelines, and Institute for Clinical and Economic Review assessments. Drugs were rated on a 4-tier scale (A-D) based on comparative net health benefit. Initial offers were then estimated by applying market-based discounts depending on the availability and type (branded vs generic) of therapeutic alternatives.</p><p><strong>Results: </strong>For 6 drugs, statutory or Big 4/Federal Supply Schedule prices anchored the estimated initial offers. Four drugs were informed by clinically comparable branded alternatives, leading to approximately 20% reductions from net price. Two drugs with primarily generic alternatives received larger discounts of approximately 30%. Three drugs with therapeutic alternatives previously negotiated in Initial Price Applicability Year 2026 were assigned either the established maximum fair price or a market-based premium (semaglutide). Across all 15 drugs, estimated discounts ranged from 32% to 78% off list price and 16% to 56% off net price.</p><p><strong>Conclusions: </strong>Our analysis highlights how Centers for Medicare and Medicaid Services may incorporate statutory discounts, prior maximum fair prices, and comparative effectiveness evidence into initial price offers, although uncertainty remains. An explicit health technology assessment framework could strengthen future negotiation cycles unless international price referencing policy intercedes.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extending Multidimensional Thresholding to Include Categorical Attributes","authors":"Jennifer A. Whitty PhD ,&nbsp;Nicolas Krucien PhD ,&nbsp;Caitlin Thomas MSc ,&nbsp;Jaein Seo PharmD ,&nbsp;Sebastian Heidenreich PhD","doi":"10.1016/j.jval.2025.05.018","DOIUrl":"10.1016/j.jval.2025.05.018","url":null,"abstract":"<div><h3>Objectives</h3><div>Multidimensional thresholding (MDT) elicits preferences at the individual level but assumes attribute-level ranges are infinitely divisible, restricting the inclusion of categorical attributes in the design. This article presents a novel framework for including categorical attributes in MDT and outlines a design process to include a single categorical attribute alongside continuous attributes.</div></div><div><h3>Methods</h3><div>The proposed approach involves 4 steps: (1) rank categories of the categorical attribute and use point allocation to score each category, (2) rank the relative importance of scale swings across all attributes, (3) undertake a series of thresholding exercises among continuous attributes, and (4) trade the scale swing in the categorical attribute against partial swings in the continuous attribute ranked 1 place higher. Computational experiments were used to determine the precision with which preference weights for a categorical attribute can be obtained.</div></div><div><h3>Results</h3><div>The results suggest that a categorical attribute can be included in MDT with modest loss of precision, on average, compared with continuous attributes. The loss of precision is a function of the importance of the scale swing of the categorical attribute, with greater imprecision when the categorical attribute is ranked first. The number of continuous attributes and the number of choice tasks had little influence on precision.</div></div><div><h3>Conclusions</h3><div>Including a categorical attribute in MDT is feasible and extends the potential application of MDT, particularly if the swing in the categorical attribute is not expected to be the most important attribute for most participants. Future research should test the method in relevant applications.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 10","pages":"Pages 1558-1564"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}