ArticleThe patient2026
Who Prefers Death to Life in Composite Time Trade-off Interviews, and Why? A Mixed-Methods Study among Asians in Singapore.
Article in The patient, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- EQ-5D-5L population norms for Singapore: a household survey-based analysis.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2026Article
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Authors and funding
6 authors.
Funding
Abstract
objectivesThe EuroQol Valuation Technology (EQ-VT) uses composite time trade-off (cTTO) with a 10-year lead-time to value health states worse-than-dead (WTD) ranging between - 1 and 0 (dead). While WTD responses are common in EQ-5D-5L studies, their drivers remain understudied in Asia. This mixed-methods study explored socio-demographic factors and reasoning behind WTD preferences in Singapore.
methodsWe recruited 500 adult Singaporeans using quota sampling. Each participant completed 20 cTTO tasks through computer-assisted interviews, followed by open- and closed-ended questions. Two-part regression models assessed both the likelihood and the extent of WTD ratings, and qualitative content analysis evaluated participants' reasoning for their health state valuations.
resultsOf the 500 participants (mean age 48.1 years; 52.6% had tertiary education), 76.8% identified as Chinese. Overall, 33.0% assigned WTD values, and 16.1% assigned '- 1' values. Age, education, marital status, interviewer and caregiving experience were associated with WTD ratings, though none remained significant in the multivariable analysis. Similar factors were linked to '- 1' values, with middle age being the only factor that remained significant in the multivariable analysis. Qualitative data showed that middle-aged participants often cited worries about imposing physical, mental, or financial burdens on their families.
conclusionsPreferences for immediate death over living in poor health are common in Singapore, particularly among middle-aged respondents. Concerns about burdening family members appear to drive these preferences, reflecting broader cultural values. These insights may clarify the high frequency of '-1' values in EQ-5D valuation studies across Asia.
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