TAILIEUCHUNG - Schmidt and Stolpe Health Economics Review 2011, 1:12

Schmidt and Stolpe Health Economics Review 2011, 1:12 RESEARCH Open Access Transitivity in health utility measurement: An experimental analysis Ulrich Schmidt1,2 and Michael Stolpe1* Abstract Several experimental studies have observed substantial violations of transitivity for decisions between risky lotteries over monetary outcomes. The goal of our experiment is to test whether these violations also affect the evaluation of health states. A particular feature of our experimental design is that it takes into account the possible role of decision errors for generating violations of transitivity. Since we find neither substantial nor systematic deviations from transitive choice behaviour, we can conclude that previously reported violations do. | Schmidt and Stolpe Health Economics Review 2011 1 12 http content 1 1 12 o Health Economics Review a SpringerOpen Journal RESEARCH Open Access Transitivity in health utility measurement An experimental analysis Ulrich Schmidt1 2 and Michael Stolpe 1 Abstract Several experimental studies have observed substantial violations of transitivity for decisions between risky lotteries over monetary outcomes. The goal of our experiment is to test whether these violations also affect the evaluation of health states. A particular feature of our experimental design is that it takes into account the possible role of decision errors for generating violations of transitivity. Since we find neither substantial nor systematic deviations from transitive choice behaviour we can conclude that previously reported violations do not seem to bias health utility measurement. Keywords Transitivity health utility errors 1 Introduction Health utility measurement plays an important role in medical decision making in particular in cost-effectiveness analyses of alternative treatments. A central assumption in health utility measurement is that preferences satisfy transitivity. Transitivity demands that whenever option A is preferred to option B and B is preferred to C then A has to be preferred to C. In the absence of transitivity a well-defined utility function U . for all options A and B we have U A U B if and only if A is weakly preferred to B does not exist. Consequently standard methods in health utility measurement such as the time tradeoff method or quality adjusted life years cannot be meaningfully applied in the absence of transitivity. Several empirical studies observed substantial violations of transitivity in particular for choice between risky options . 1-8 . The validity of health utility measurement would be seriously challenged if these violations carried over to the evaluation of health states No consistent rankings of health states could be .

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