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A Pilot Study of Valuation Methods of the EQ-5D and the Impact of Literacy, Cultural, and Religious Factors on Preferences.

  • Malik, Madeeha1
  • Gu, Ning Yan2
  • Hussain, Azhar3
  • Saleem, Saniya4
  • Purba, Fredrick Dermawan5
  • Al Sayah, Fatima6
  • 1 Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan. Electronic address: [email protected] , (Mali)
  • 2 University of San Francisco, Sacramento, CA, USA.
  • 3 Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan. , (Pakistan)
  • 4 Global Health Directorate, Indus Health Network, Karachi, Pakistan. , (Pakistan)
  • 5 Faculty of Psychology, Universitas Padjadjaran, Indonesia. , (Indonesia)
  • 6 School of Public Health, University of Alberta, Edmonton, AB, Canada. , (Canada)
Published Article
Value in health regional issues
Publication Date
Jul 01, 2022
DOI: 10.1016/j.vhri.2021.10.003
PMID: 35144144


This study aimed to examine the feasibility of the 3-level-EQ-5D valuation methods and the impact of literacy, culture, and religion on the preferences of the Pakistani population. Respondents aged 18 to 65 years were recruited using quota sampling. The EuroQol Portable Valuation Technology was used, and data collection was done in Urdu. Graphical presentations were used to elicit responses from illiterate respondents. All interviews were audio recorded and transcribed. Odds ratios associated with the choice impact were assessed. Usual activities showed highest impact on respondents' choice outcomes, followed by self-care and then anxiety/depression and mobility. Compared with "no problem," any problems in mobility had higher odds for a respondent to not to choose otherwise. The impact of health impairment on usual activities imposed the highest influences choices made. Most of the respondents reported that religion had no impact on their responses. Compared with literate respondents, illiterate respondents were more likely to be older, were unemployed, resided in rural, had lower self-reported health, had lower education/income, and had family members living in the same household with lower income. Although not significant, the number of nontraders was slightly higher in illiterate respondents. Literate respondents indicated cultural beliefs did not affects their responses whereas most of the illiterate respondents highlighted the impact of cultural norms on their responses, especially for self-care. Preference elicitation methods used in 3-level-EQ-5D valuation studies, namely, time trade-off and discrete choice experiments, are feasible in the Pakistani population. The use of graphical illustrations for illiterate respondents was successful. Copyright © 2021 ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc. All rights reserved.

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