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The social value of a quality-adjusted life-year (QALY) is influenced by disease severity, not age. Understanding public preferences is key for equitable healthcare prioritization and resource allocation.

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Area of Science:

  • Health Economics
  • Decision Science
  • Public Health

Background:

  • Assessing healthcare intervention cost-effectiveness requires comparing incremental costs per quality-adjusted life-year (QALY) gained against a threshold reflecting the monetary value of health gains.
  • The equity context of health gains can influence this value, but the monetary value of a QALY concerning equity has been underexplored.

Purpose of the Study:

  • To estimate the social marginal willingness to pay (MWTP) for QALY gains across different equity subgroups.
  • To investigate whether illness severity (proportional shortfall) and age (fair innings) influence the value of health gains.

Main Methods:

  • A discrete choice experiment (DCE) was conducted with 1205 representative adult respondents in the Netherlands.
  • Data were analyzed using panel mixed multinomial logit (MMNL) and latent class models to identify preference patterns.

Main Results:

  • MMNL models yielded counterintuitive results, suggesting more severe health states decreased treatment probability.
  • Latent class models identified distinct preferences, indicating MWTP for QALYs was sensitive to disease severity for many, but not age.

Conclusions:

  • Public preferences for healthcare prioritization are heterogeneous and must be considered in research and policy.
  • Further exploration of the monetary value of a QALY in relation to equity is crucial for informed decision-making.