Valuing QALYs in Relation to Equity Considerations Using a Discrete Choice Experiment

Overview

Journal Pharmacoeconomics

Specialty Pharmacology

Date 2015 Aug 2

PMID 26232199

Citations 17

Authors

Liesbet van de Wetering

Job van Exel

Ana Bobinac

Werner B F Brouwer

Affiliations

Soon will be listed here.

Abstract

Background: To judge whether an intervention offers value for money, the incremental costs per gained quality-adjusted life-year (QALY) need to be compared with some relevant threshold, which ideally reflects the monetary value of health gains. Literature suggests that this value may depend on the equity context in which health gains are produced, but the value of a QALY in relation to equity considerations has remained largely unexplored.

Objective: The objective of this study was to estimate the social marginal willingness to pay (MWTP) for QALY gains in different equity subgroups, using a discrete choice experiment (DCE). Both severity of illness (operationalized as proportional shortfall) and fair innings (operationalized as age) were considered as grounds for differentiating the value of health gains.

Methods: We obtained a sample of 1205 respondents, representative of the adult population of the Netherlands. The data was analysed using panel mixed multinomial logit (MMNL) and latent class models.

Results: The panel MMNL models showed counterintuitive results, with more severe health states reducing the probability of receiving treatment. The latent class models revealed distinct preference patterns in the data. MWTP per QALY was sensitive to severity of disease among a substantial proportion of the public, but not to the age of care recipients.

Conclusion: These findings emphasize the importance of accounting for preference heterogeneity among the public on value-laden issues such as prioritizing health care, both in research and decision making. This study emphasises the need to further explore the monetary value of a QALY in relation to equity considerations.

Citing Articles

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References

Culyer A, McCabe C, Briggs A, Claxton K, Buxton M, Akehurst R . Searching for a threshold, not setting one: the role of the National Institute for Health and Clinical Excellence. J Health Serv Res Policy. 2007; 12(1):56-8. DOI: 10.1258/135581907779497567. View

Dolan P, Tsuchiya A . Health priorities and public preferences: the relative importance of past health experience and future health prospects. J Health Econ. 2005; 24(4):703-14. DOI: 10.1016/j.jhealeco.2004.11.007. View

Hole A . Modelling heterogeneity in patients' preferences for the attributes of a general practitioner appointment. J Health Econ. 2008; 27(4):1078-1094. DOI: 10.1016/j.jhealeco.2007.11.006. View

Green C, Gerard K . Exploring the social value of health-care interventions: a stated preference discrete choice experiment. Health Econ. 2008; 18(8):951-76. DOI: 10.1002/hec.1414. View

Shah K . Severity of illness and priority setting in healthcare: a review of the literature. Health Policy. 2009; 93(2-3):77-84. DOI: 10.1016/j.healthpol.2009.08.005. View

Rawlins M, Barnett D, Stevens A . Pharmacoeconomics: NICE's approach to decision-making. Br J Clin Pharmacol. 2010; 70(3):346-9. PMC: 2949905. DOI: 10.1111/j.1365-2125.2009.03589.x. View

Bobinac A, van Exel N, Rutten F, Brouwer W . Willingness to pay for a quality-adjusted life-year: the individual perspective. Value Health. 2010; 13(8):1046-55. DOI: 10.1111/j.1524-4733.2010.00781.x. View

Claxton K, Paulden M, Gravelle H, Brouwer W, Culyer A . Discounting and decision making in the economic evaluation of health-care technologies. Health Econ. 2010; 20(1):2-15. DOI: 10.1002/hec.1612. View

Lancsar E, Wildman J, Donaldson C, Ryan M, Baker R . Deriving distributional weights for QALYs through discrete choice experiments. J Health Econ. 2011; 30(2):466-78. DOI: 10.1016/j.jhealeco.2011.01.003. View

10.

Mentzakis E, Ryan M, McNamee P . Using discrete choice experiments to value informal care tasks: exploring preference heterogeneity. Health Econ. 2010; 20(8):930-44. DOI: 10.1002/hec.1656. View

11.

Diederich A, Winkelhage J, Wirsik N . Age as a criterion for setting priorities in health care? A survey of the German public view. PLoS One. 2011; 6(8):e23930. PMC: 3164130. DOI: 10.1371/journal.pone.0023930. View

12.

de Bekker-Grob E, Ryan M, Gerard K . Discrete choice experiments in health economics: a review of the literature. Health Econ. 2012; 21(2):145-72. DOI: 10.1002/hec.1697. View

13.

Bobinac A, van Exel N, Rutten F, Brouwer W . Inquiry into the relationship between equity weights and the value of the QALY. Value Health. 2012; 15(8):1119-26. DOI: 10.1016/j.jval.2012.07.002. View

14.

van de Wetering E, Stolk E, van Exel N, Brouwer W . Balancing equity and efficiency in the Dutch basic benefits package using the principle of proportional shortfall. Eur J Health Econ. 2011; 14(1):107-15. PMC: 3535361. DOI: 10.1007/s10198-011-0346-7. View

15.

Norman R, Hall J, Street D, Viney R . Efficiency and equity: a stated preference approach. Health Econ. 2012; 22(5):568-81. DOI: 10.1002/hec.2827. View

16.

Bobinac A, van Exel N, Rutten F, Brouwer W . Valuing QALY gains by applying a societal perspective. Health Econ. 2012; 22(10):1272-81. DOI: 10.1002/hec.2879. View

17.

Olsen J . Priority preferences: "end of life" does not matter, but total life does. Value Health. 2013; 16(6):1063-6. DOI: 10.1016/j.jval.2013.06.002. View

18.

Nord E, Johansen R . Concerns for severity in priority setting in health care: a review of trade-off data in preference studies and implications for societal willingness to pay for a QALY. Health Policy. 2014; 116(2-3):281-8. DOI: 10.1016/j.healthpol.2014.02.009. View

19.

Whitty J, Lancsar E, Rixon K, Golenko X, Ratcliffe J . A systematic review of stated preference studies reporting public preferences for healthcare priority setting. Patient. 2014; 7(4):365-86. DOI: 10.1007/s40271-014-0063-2. View

20.

Skedgel C, Wailoo A, Akehurst R . Societal preferences for distributive justice in the allocation of health care resources: a latent class discrete choice experiment. Med Decis Making. 2014; 35(1):94-105. DOI: 10.1177/0272989X14547915. View