Trading people versus trading time: what is the difference?


Journal Article

BACKGROUND: Person trade-off (PTO) elicitations yield different values than standard utility measures, such as time trade-off (TTO) elicitations. Some people believe this difference arises because the PTO captures the importance of distributive principles other than maximizing treatment benefits. We conducted a qualitative study to determine whether people mention considerations related to distributive principles other than QALY-maximization more often in PTO elicitations than in TTO elicitations and whether this could account for the empirical differences. METHODS: 64 members of the general public were randomized to one of three different face-to-face interviews, thinking aloud as they responded to TTO and PTO elicitations. Participants responded to a TTO followed by a PTO elicitation within contexts that compared either: 1) two life-saving treatments; 2) two cure treatments; or 3) a life-saving treatment versus a cure treatment. RESULTS: When people were asked to choose between life-saving treatments, non-maximizing principles were more common with the PTO than the TTO task. Only 5% of participants considered non-maximizing principles as they responded to the TTO elicitation compared to 68% of participants who did so when responding to the PTO elicitation. Non-maximizing principles that emerged included importance of equality of life and a desire to avoid discrimination. However, these principles were less common in the other two contexts. Regardless of context, though, participants were significantly more likely to respond from a societal perspective with the PTO compared to the TTO elicitation. CONCLUSION: When lives are at stake, within the context of a PTO elicitation, people are more likely to consider non-maximizing principles, including the importance of equal access to a life-saving treatment, avoiding prejudice or discrimination, and in rare cases giving treatment priority based purely on the position of being worse-off.

Full Text

Duke Authors

Cited Authors

  • Damschroder, LJ; Roberts, TR; Goldstein, CC; Miklosovic, ME; Ubel, PA

Published Date

  • November 10, 2005

Published In

Volume / Issue

  • 3 /

Start / End Page

  • 10 -

PubMed ID

  • 16281982

Pubmed Central ID

  • 16281982

Electronic International Standard Serial Number (EISSN)

  • 1478-7954

International Standard Serial Number (ISSN)

  • 1478-7954

Digital Object Identifier (DOI)

  • 10.1186/1478-7954-3-10


  • eng