Stevanus Pangestu

Objectives: This study qualitatively explored how bolt-ons affect the perception of EQ-5D-5L core dimensions in a valuation context. Methods: Sixty Indonesian adults (aged 20–67 y, 50% female) each valued 10 health states using composite time tradeoff (cTTO). States were presented in either forward (EQ-5D-5L, then with 1 bolt-on, then 2) or backward (reversed sequence) order. Participants were assigned to 1 of 3 bolt-on dyads: vision and tiredness, cognition and social relationships, or skin irritation and self-confidence. In semistructured qualitative interviews, respondents described how adding or removing bolt-ons changed the perceived importance of the 5 core dimensions. We classified these changes as related either to measurement or to valuation, with the latter further categorized as a relative or absolute shift in importance. Results: Cognition and vision generated the most shifts in perceived importance in the forward and backward groups, respectively. Regardless of ordering group, most shifts occurred between the EQ-5D-5L alone and the version with 1 bolt-on (first presented in the dyad), with significantly fewer shifts observed between the 1-bolt-on and 2-bolt-on states. In the forward group, most shifts were classified as measurement (56%) or relative preference (29%), while the reverse was true in the backward group: relative preference (53%) or measurement (31%). Absolute preference was least common across both groups. Conclusions: This is the first study to explore how individuals reason when valuing EQ-5D-5L+bolt-on health states. Our findings suggest that interactions between dimensions are complex and may be influenced by presentation order. Further qualitative research should directly investigate absolute preferential reasoning. Highlights: No studies have qualitatively explored how individuals value EQ-5D health states with bolt-ons. Understanding how bolt-ons influence reasoning and interact with core dimensions is crucial for informing valuation methods and modeling strategies. Our findings show that bolt-ons can alter how participants perceive the importance of EQ-5D-5L dimensions, although changes are mostly not preference driven. Participants often rely on accessible reasoning, such as conceptual associations between dimensions. Effects vary by the bolt-on used and presentation order. Interactions between bolt-ons and core dimensions complicate efforts to develop robust valuation approaches. Future qualitative studies should aim to capture preference-based reasoning, while quantitative work is needed to disentangle preferential from nonpreferential effects.

Background: The EQ-5D-Y-3L is a generic, preference-accompanied health measure intended for pediatric populations. EQ-5D-Y-3L health states are valued using the perspective of a hypothetical 10-year-old child (‘child perspective’) rather than adults valuing for themselves (‘adult perspective’). The perspective used has been shown to influence valuation outcomes, affecting comparability of health utilities. This study explored within-respondent differences in values between adult and child perspectives using data from Hungary. Methods: A secondary analysis was conducted using composite time trade-off (cTTO) data from the Hungarian EQ-5D-Y-3L valuation study. Two hundred adults valued 10 health states from the child perspective and four from the adult perspective. The cTTO values for the matched health states (valued from both perspectives) were compared, with differences analyzed using t-tests and random-intercept regression. Associations with respondent characteristics were also explored. Results: Differences in cTTO values were observed between perspectives, particularly for more severe health states. Compared to the adult perspective, the child perspective yielded significantly lower values for worse-than-dead observations, but higher values for better-than-dead observations. After adjusting for within-subject variation and respondent characteristics, perspective was not a significant predictor of cTTO values. Instead, differences were partly explained by education, region of residence, parental status, and the view that a child’s life is more valuable than an adult’s. Conclusions: This is the first study to explore perspective differences in EQ-5D-Y-3L health state valuation within respondents using nationally representative data from outside Western Europe. The findings highlight the importance of considering individual-level attributes in pediatric health valuation.

Objectives: Financial toxicity (FT) is the impairment of financial well-being experienced by patients with cancer, categorized into subjective (SFT) and objective (OFT) forms. This study aimed to investigate the associations between FT, health-related quality of life, and overall well-being in patients with breast cancer. Methods: We analyzed baseline data from a single-center longitudinal study in Indonesia. Patients completed the EQ-5D-5L, EQ Health and Wellbeing (EQ-HWB), COST: A FACIT Measure of Financial Toxicity (FACIT-COST, for measuring SFT), and OFT-related questions. Ordinal logistic regression was used to examine the associations between FT and selected EQ-5D-5L and EQ-HWB items. Multivariable linear regression was used to assess the associations of FT and EQ-5D-5L and EQ-HWB-S index values. The main regression models were adjusted for socio-demographic and clinical factors such as age, income, metastasis status, and symptoms. Results: The survey included 300 female patients with breast cancer undergoing treatment (mean age = 51). Overall, 21% experienced high SFT (FACIT-COST ≤ 17.5) and 51% reported any OFT (e.g., incurring debt). Adjusted for covariates, higher SFT was associated with more problems in EQ-5D-5L pain/discomfort and anxiety/depression, and in EQ-HWB exhaustion, anxiety, sadness/depression, frustration, pain, and discomfort. OFT was associated with more problems in exhaustion. Higher SFT was associated with lower EQ-5D-5L and EQ-HWB-S index values, with explained variances of 46.3% for EQ-HWB-S and 31.2% for EQ-5D-5L. Conclusions: This study is the first to explore the associations between financial toxicity, EQ-5D-5L, and EQ-HWB outcomes in breast cancer. Our findings provide insight into the cancer burden and its link to health and well-being.

Financial toxicity describes the impairment of financial wellbeing in patients due to the burden of cancer diagnosis and care. The COST: A Functional Assessment of Chronic Illness Therapy Measure of Financial Toxicity (FACIT-COST) is the most widely used cancer-specific measure of subjective financial toxicity, having been validated in multiple languages, but not in Indonesian. This study aimed to validate the Indonesian version of FACIT-COST in a breast cancer sample. A single-center prospective cohort study was performed in Indonesia. Female breast cancer patients aged ≥ 18 undergoing treatment at baseline were invited to participate and followed for up to six months. The survey included the official Indonesian version of FACIT-COST (v2) which was administered to the patients by interviewers. Clinical information (e.g., metastasis status, disease duration) was provided based on medical records. The following measurement properties of FACIT-COST were tested: distributional characteristics, structural validity (principal component [PCA] and confirmatory factor analyses [CFA]), internal consistency reliability (Cronbach’s alpha and McDonald’s omega), known-groups validity (Mann-Whitney U or Kruskal-Wallis H test), test-retest reliability, and responsiveness to change. Overall, 300 female patients participated at baseline. No patients reported the best or worst possible FACIT-COST total scores. The PCA proposed a two-factor model structure for the instrument, which was confirmed by the CFA (RMSEA = 0.042, SRMR = 0.049, CFI = 0.99, TLI = 0.99). The internal consistency reliability of the two factors was considered adequate (Cronbach’s alpha = 0.774–0.882, McDonald’s omega = 0.786–0.888). The FACIT-COST total score significantly discriminated across the following known-groups: age, education, residential setting, income, employment, metastasis status, number of symptoms, and financial coping strategies. The FACIT-COST demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.96) and satisfactory responsiveness to change (standardized response mean and effect size ranges=|0.39| to |0.92|). This is the first study to validate the FACIT-COST in patients with breast cancer and to present the measurement properties of the Indonesian version of FACIT-COST. The Indonesian FACIT-COST demonstrates acceptable psychometric performance and shows potential as a valid measure of subjective financial toxicity. The instrument may serve as a valuable tool for informing health policies that focus on providing resource support to improve cancer care in Indonesia.

The purpose of this research is to analyze the influence of financial literacy and materialism on the savings decision of Indonesia’s generation Z. This study was motivated by the country’s agenda to achieve financial inclusion and develop human resources throughout the nation. We distributed questionnaires to 430 university students to measure their financial literacy score and materialism level, as well as the savings rate of every respondent. Through a series of regression analyses, we find that (i) age, gender, and major of study significantly influence financial literacy score; (ii) financial literacy positively influences savings decision; and (iii) materialism negatively influences savings decision. Our findings generally foretell favourable financial conditions for future generations of Indonesians. Finally, we also strongly recommend policymakers to start integrating financial education as a compulsory part of every school’s curriculum, regardless of level.

This paper investigates financial toxicity of patients with cancer and survivors in Indonesia and how this condition affects their risk attitude. Financial toxicity is the harmful financial burden caused by cancer treatment. Data were collected using questionnaires. We adopted Comprehensive Score for Financial Toxicity (COST) measure and Domain-Specific-Risk-Taking (DOSPERT) scale to measure our variables. Our analysis shows that financial toxicity is experienced by the respondents (n = 194). We also find that risk attitude is not only influenced by financial toxicity, but also by age, number of dependent children, cancer stage, religious disaffiliation, and the use of health insurance.