Learning and satisficing: an analysis of sequence effects in health valuation.

OBJECTIVE To estimate the effect of sequence on response precision and response behavior in health valuation studies. METHODS Time trade-off (TTO) and paired comparison responses from six health valuation studies-four US, one Spanish, and one Dutch-were examined (22,225 respondents) to test whether task sequence influences response precision (e.g., rounding), response changes, and median response times. Each study used a computer-based instrument that randomized task sequence among a national sample of adults, age 18 years or older, from the general population. RESULTS For both TTO and paired comparisons, median response times decreased with sequence (i.e., learning), but tended to flatten after the first three tasks. Although the paired comparison evidence demonstrated that sequence had no effect on response precision, the frequency of rounded TTO responses (to either 1-year or 5-year units) increased with sequence. CONCLUSIONS Based on these results, randomizing or reducing the number of paired comparison tasks does not appear to influence response precision; however, generalizability, practicality, and precautionary considerations remain. Overall, participants learned to respond efficiently within the first three tasks and did not resort to satisficing, but may have rounded their TTO responses.