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Are some QALYs more equal than others?
E J van de Wetering1, N J A van Exel2, J M Rose3
1Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, DR, 3000, The Netherlands. vandewetering@bmg.eur.nl.
Summary
Societal preferences significantly impact healthcare allocation. This study reveals how factors like illness severity, age, culpability, dependents, and disease rarity influence public choices in health resource distribution.
Area of Science:
- Health Economics
- Public Health Policy
- Decision Science
Background:
- Healthcare allocation decisions are complex, requiring integration of societal values.
- Understanding public preferences is crucial for equitable distribution of health and healthcare resources.
Purpose of the Study:
- To investigate societal preferences for health and healthcare allocation using a discrete choice experiment.
- To assess the influence of various attributes, including equity principles and beneficiary/disease characteristics, on these preferences.
Main Methods:
- A phased discrete choice experiment was conducted.
- A nested logit model was employed to analyze respondent choices.
- Attributes included severity of illness, fair innings (age), culpability, dependents, and disease rarity.
Main Results:
- All investigated attributes significantly influenced respondents' allocation preferences.
- The phased inclusion of attributes demonstrated their impact on preferences for previously considered attributes.
- Additional attributes led to a reduction in unobserved variance, refining preference estimations.
Conclusions:
- Societal preferences are complex and influenced by multiple factors beyond traditional equity principles.
- Discrete choice experiments are valuable tools for understanding nuanced public preferences in healthcare allocation.
- While some attributes may not align with normative decision-making, their inclusion enhances understanding of societal values in health resource distribution.
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