How dead is dead? Qualitative findings from participants of combined traditional and lead-time time trade-off valuations

Purpose The EuroQol Valuation Technology (EQ-VT) uses traditional time trade-off (tTTO) for health states better than dead and lead-time TTO (LT-TTO) for states worse than dead to elicit a value (−1.0 to +1.0) for each health state. In the Canadian EQ-5D-5L Valuation study which used the EQVT platform, we observed an unexpected peak in frequency of “0” values and few negative values, particularly in the range of 0 to −0.5. To better understand this finding, we sought to explore respondents’ thought processes while valuing a health state, and their understanding of the tTTO and LT-TTO exercises.