Background: Conditions were studied that may invalidate health-state values derived from the visual analogue scale (VAS). Methods: Respondents were asked to place cards with descriptions of EQ-5D health states on a 20 cm EuroQol VAS and modified versions of it, positioning them such that the distances between the states reflect their valuation for these states. Anchor-point bias was examined using the standard EuroQol VAS (n = 212) and a modified version (n = 97) with a different lower anchor. Context bias was examined in another group of respondents (n = 112) who valued three different sets of EQ-5D health states. Marker bias was studied in yet another group of respondents (n = 100) who placed the same EQ-5D states on the standard EuroQol VAS and on a modified VAS without anchors, categories, or measurement markers. Results: No indication for the existence of the anchor-point and the marker bias was found. However, the VAS valuations were significantly affected by the context of the set of health states in the scaling task. Conclusion: Advanced methodologies should be incorporated in VAS valuation studies to deal with the context bias.

Bias, Health states, Measurement, Valuation techniques, Visual analogue scale,
Quality of Life Research
Department of Medical Psychology and Psychotherapy

Krabbe, P.F.M, Stalmeier, P.F.M, Lamers, L.M, & van Busschbach, J.J. (2006). Testing the interval-level measurement property of multi-item visual analogue scales. Quality of Life Research, 15(10), 1651–1661. doi:10.1007/s11136-006-0027-7