# Does context matter? A discrete choice experiment investigating the impact of palliative context on EQ-5D-5L health state valuation

## TL;DR

This study shows that how health states are valued in palliative care depends on the context, like life expectancy and support availability.

## Contribution

The study introduces a new method to assess how palliative care context affects health state valuations using discrete choice experiments.

## Key findings

- Health state valuations differ when framed in a palliative context compared to context-free scenarios.
- Life expectancy had a larger impact on valuations than the level of support.
- More health states were valued as worse than death in palliative contexts, especially in Australia and the UK.

## Abstract

Ensuring the values applied in health technology assessment of palliative care accurately reflect the palliative context is crucial for informed and effective resource allocation. The aim of this study is to examine whether the valuation of EQ-5D health states varies when framed within a palliative care needs context: limited life expectancy and availability of supports.

This study was a multinational cross-sectional discrete choice experiment (DCE) with respondents from the general populations of Australia (n = 2,082), Ireland (n = 1,280), and the UK (n = 2,009). Each participant was presented with a series of 20 choice sets, in which they were asked to choose between two EQ-5D-5L health states and immediate death. Half of the choice sets were accompanied by a “context vignette” while the remaining half were “context-free”. The context vignettes, developed through a four-stage iterative process, described four distinct levels of palliative care needs. A D-efficient DCE design was developed, and the data were analysed using multinomial logit regression models.

The study found inconsistencies in the EQ-5D-5L health state valuations in palliative contexts compared with context free valuation. Both life expectancy and level of support impacted health state valuation, with life expectancy having the larger effect. The inclusion of the palliative care vignettes substantially increased the number of health states that were given values worse than dead. This increase was more pronounced in Australia and the UK than in Ireland.

These results imply that EQ-5D value sets that are context free require careful interpretation, especially when applied in settings such as palliative care.

The online version contains supplementary material available at 10.1007/s11136-025-04023-9.