Why English? | Reporting CREATE Health-State Valuation Studies Through Attributes, Participants, Preference Tasks, Modelling, Results and Uncertainty

ORIENTATION

What this guide covers

Current fact check

CREATE was published in PharmacoEconomics volume 33, pages 867–877, in 2015, DOI 10.1007/s40273-015-0292-9 and PubMed ID 26026667. The published paper describes a modified two-round Delphi process plus an email survey and a final 21-item checklist across seven sections.

What this guide does not cover

This article focuses on reporting valuation studies for multi-attribute utility-based instruments. It does not calculate a real value set, advise on treatment or funding, rank the worth of people, replace CHEERS or local health-technology-assessment requirements, or claim that one preference method is universally best.

Worked example

Every chapter returns to a fictional national study valuing a child-friendly health-status instrument for use in economic evaluation, with age-appropriate safeguards and adult general-population respondents. It is fictional, low-stakes and educational; it does not report a real school, clinical decision or guaranteed outcome.

Warm up with eduKate’s guides to explaining scientific evidence and asking better questions in class.

CHAPTER 1 OF 15

1. Describe the Instrument and Its Purpose

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Why this move matters

Name the instrument, version, target population, attributes, levels and intended use.

Trace preferences into a value set

Name the instrument, version, target population, attributes, levels and intended use. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: The fictional instrument describes mobility, pain, mood, learning and social participation for children. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

An instrument’s popularity does not validate a new value set. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Describe the Instrument and Its Purpose”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 2 OF 15

2. Explain the Health-State Descriptive System

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Why this move matters

Report how attributes and levels combine, wording, ordering, examples and any changes.

Trace preferences into a value set

Report how attributes and levels combine, wording, ordering, examples and any changes. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: Each attribute has four ordered levels written in plain, age-sensitive language. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

Ordered labels may not feel equally spaced. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Explain the Health-State Descriptive System”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 3 OF 15

3. Show How Health States Were Selected

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Why this move matters

Explain the full state space, design for selecting valued states, anchors and coverage.

Trace preferences into a value set

Explain the full state space, design for selecting valued states, anchors and coverage. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: The study samples states to cover severity and interactions rather than choosing only easy examples. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

A small valued subset must support inference to unobserved states. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Show How Health States Were Selected”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 4 OF 15

4. Report Translation and Cultural Adaptation

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Why this move matters

Describe forward and backward work, cognitive testing, conceptual equivalence and unresolved terms.

Trace preferences into a value set

Describe forward and backward work, cognitive testing, conceptual equivalence and unresolved terms. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: Bilingual interviews reveal that one participation phrase implies school attendance rather than broader social life. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

Literal equivalence is not conceptual equivalence. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Report Translation and Cultural Adaptation”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 5 OF 15

5. Define the Valuation Population

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Why this move matters

State whether respondents are the general public, patients or another group and explain why.

Trace preferences into a value set

State whether respondents are the general public, patients or another group and explain why. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: Adults from the general population provide societal preferences under the stated policy context. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

Different populations may value states differently. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Define the Valuation Population”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 6 OF 15

6. Describe Sampling, Recruitment and Representativeness

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Why this move matters

Report frame, method, quotas, invitations, response, incentives, exclusions and comparison with the target population.

Trace preferences into a value set

Report frame, method, quotas, invitations, response, incentives, exclusions and comparison with the target population. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: Sampling balances age, sex, region and education while reporting deviations after non-response. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

Quota balance on a few variables does not guarantee representativeness. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Describe Sampling, Recruitment and Representativeness”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 7 OF 15

7. Explain Preference Tasks in Plain Language

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Why this move matters

Describe time trade-off, standard gamble, discrete choice or other tasks, examples, practice and decision rules.

Trace preferences into a value set

Describe time trade-off, standard gamble, discrete choice or other tasks, examples, practice and decision rules. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: Respondents practise with non-health examples before completing time trade-off and choice tasks. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

Technical task names do not show what people actually did. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Explain Preference Tasks in Plain Language”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 8 OF 15

8. Report Interview Mode, Visual Aids and Facilitators

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Why this move matters

State in-person or digital mode, software, layout, interviewer training, scripts, prompts and quality monitoring.

Trace preferences into a value set

State in-person or digital mode, software, layout, interviewer training, scripts, prompts and quality monitoring. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: Interviewers use a standard visual timeline and record clarification without steering choices. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

Interface design and interviewer behaviour can influence answers. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Report Interview Mode, Visual Aids and Facilitators”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 9 OF 15

9. Address Burden, Distress and Ethical Safeguards

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Why this move matters

Explain consent, difficult states, breaks, withdrawal, support, privacy and special protections.

Trace preferences into a value set

Explain consent, difficult states, breaks, withdrawal, support, privacy and special protections. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: Respondents may pause when considering severe child health states and receive a clear debrief. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

Hypothetical tasks can still be emotionally demanding. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Address Burden, Distress and Ethical Safeguards”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 10 OF 15

10. Define Data Quality and Exclusion Rules

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Why this move matters

Pre-specify completion, understanding, dominance, inconsistency, timing and exclusion criteria.

Trace preferences into a value set

Pre-specify completion, understanding, dominance, inconsistency, timing and exclusion criteria. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: The study distinguishes incomplete tasks from logically unusual but sincerely held preferences. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

Over-cleaning can remove valid minority views. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Define Data Quality and Exclusion Rules”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 11 OF 15

11. Describe the Modelling Strategy

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Why this move matters

Report dependent variable, functional form, random effects, interactions, constraints, software and rationale.

Trace preferences into a value set

Report dependent variable, functional form, random effects, interactions, constraints, software and rationale. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: Several plausible models are compared against prespecified fit and prediction criteria. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

A complex model is not automatically more credible. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Describe the Modelling Strategy”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 12 OF 15

12. Show How Anchoring and Scoring Work

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Why this move matters

Explain anchors, scale, transformations and how coefficients generate a value for every state.

Trace preferences into a value set

Explain anchors, scale, transformations and how coefficients generate a value for every state. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: The report shows how observed preferences map onto the full-health and dead reference points. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

Negative values need careful interpretation and do not mean a life lacks worth. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Show How Anchoring and Scoring Work”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 13 OF 15

13. Report Model Fit, Validation and Uncertainty

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Why this move matters

Present diagnostics, prediction error, internal or external validation, sensitivity analyses and intervals.

Trace preferences into a value set

Present diagnostics, prediction error, internal or external validation, sensitivity analyses and intervals. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: Predicted and observed values are compared for held-out states, with uncertainty shown. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

Good average fit can conceal poor prediction for severe states. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Report Model Fit, Validation and Uncertainty”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 14 OF 15

14. Present Participants, Tasks and Results Transparently

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Why this move matters

Give flow, denominators, respondent characteristics, task completion, exclusions, coefficients and the final algorithm.

Trace preferences into a value set

Give flow, denominators, respondent characteristics, task completion, exclusions, coefficients and the final algorithm. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: A flow diagram separates invited, started, completed, excluded and analysed respondents. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

A final table without participant flow hides important selection. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Present Participants, Tasks and Results Transparently”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

CHAPTER 15 OF 15

15. Interpret Use, Limits and Ethical Meaning

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Why this move matters

State policy context, transferability, distributional issues, update needs and what utility values cannot decide.

Trace preferences into a value set

State policy context, transferability, distributional issues, update needs and what utility values cannot decide. Connect the descriptive system, health states, population, sampling, preference tasks, quality controls, modelling, uncertainty and scoring algorithm.

Follow one valuation study

Worked example: The value set can inform cost-utility analysis alongside evidence, ethics, equity and public deliberation. Move from selecting health states through interviewing, exclusions, model choice, validation and publication of the value set.

Keep values separate from individual worth

A health-state utility value supports population-level comparison in economic evaluation. It does not measure a person’s moral value or settle every funding decision.

Use CREATE accurately

Utility is not a complete account of wellbeing or fairness. CREATE is a published 21-item checklist in seven sections for valuation studies of multi-attribute utility-based instruments; it does not replace economic-evaluation guidance or guarantee a fair decision.

Student, parent and career transfer

Make one evidence card for “Interpret Use, Limits and Ethical Meaning”: source location, plain-language meaning, limit and next question. A parent or teacher can ask for one everyday explanation and one specialist explanation; both must preserve the same conditions. This habit supports health economics, public health, outcomes research, psychology, statistics, medicine, pharmacy, policy, health technology assessment, survey research and ethics without promising a grade, admission, funding decision or job.

PRACTICE LAB

Build a CREATE health-state valuation reporting decision trail

Student route

1. Choose one original report inside this guide’s scope.
2. Copy its objective and underline actor, action, context, evidence and intended decision.
3. Draw the specific reasoning chain used in this article.
4. Mark each step reported, inferred, contested or unknown.
5. Rewrite the conclusion so it preserves the narrowest important limitation.

Parent or teacher route

Ask the learner to explain how English helps us report health-state valuation studies so descriptive systems, participants, preference tasks, modelling, value sets and uncertainty can be appraised twice: once to a classmate and once to a method specialist. Praise a precise correction and a well-stated unknown; both show disciplined attention to evidence.

Early-career route

Create a one-page CREATE health-state valuation reporting audit with source link, date checked, scope, method logic, decisive wording, contrary evidence, limit and next action. A colleague should be able to continue without guessing.

Continue with eduKate’s guides to reading course and career information and giving useful feedback in group projects.

USEFUL NEXT READING

Continue with a related guide

Read the ACCORD consensus-reporting guide for a related but different reader job. Return here when the question is specifically how to report health-state valuation studies so descriptive systems, participants, preference tasks, modelling, value sets and uncertainty can be appraised. Use the linked guide for its separate reader task, and this guide for the question defined here.

For English practice across research, school and career communication, visit the Singapore English Tuition Centre learning site.

FREQUENTLY ASKED QUESTIONS

Questions students and parents often ask

Is CREATE a published checklist?

Yes. The 2015 publication reports 21 items in seven sections.

What is a multi-attribute utility-based instrument?

It describes health across several attributes and can assign index values to health states using a value set.

Do utility values measure a person’s worth?

No. They are analytic inputs for particular health-economic comparisons, not moral rankings of people.

Why does wording matter?

Participants respond to descriptions, so unclear or culturally mismatched wording can change the state they imagine.

Should unusual answers be deleted?

Not automatically. Exclusion rules need justification because unusual preferences may be genuine.

Does CREATE replace CHEERS?

No. CREATE addresses valuation-study reporting; a full economic evaluation may need other guidance such as CHEERS.