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Updated: Sep 15, 2025

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Two Approaches for Measuring Treatment Value Under Uncertainty: Estimating Insurance Value and Risk Preferences in

Jason Shafrin1, Kyi-Sin Than2, Jacob Fajnor1

  • 1FTI Consulting, 350 S. Grand Ave. Suite 3000, Los Angeles, CA 90071, USA.

Forum for Health Economics & Policy
|July 15, 2025
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Summary

Neurological treatments are undervalued by traditional cost-effectiveness methods. This study shows individuals are risk-averse and willing to pay more for treatments delaying cognitive and mobility impairments, highlighting the need for risk-adjusted analyses.

Keywords:
broader value elements; health-related quality of lifeinsurance valueneurology

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Area of Science:

  • Health Economics
  • Neuroscience
  • Decision Analysis

Background:

  • Neurological conditions cause significant quality-of-life decrements and financial burdens.
  • Traditional cost-effectiveness analyses may undervalue neurological treatments by assuming risk neutrality.
  • Risk preferences over neurological health states are crucial for accurate economic evaluations.

Purpose of the Study:

  • To quantify the insurance value of hypothetical treatments delaying cognitive and physical impairments in neurological conditions.
  • To measure risk preferences over neurological health states for generalized risk-adjusted cost-effectiveness (GRACE) analyses.
  • To inform economic evaluations by incorporating patient risk aversion.

Main Methods:

  • Two national surveys were conducted using a multiple random staircase design to elicit willingness-to-pay (WTP) for hypothetical treatments.
  • Insurance value was calculated as WTP exceeding the risk-neutral quality-adjusted life year (QALY)-based value.
  • Risk aversion was measured using health-related quality of life (HRQoL) estimations and choice experiments (Holt and Laury method).

Main Results:

  • WTP for cognitive impairment delay treatment was $646.88/year (vs. $260.80 risk-neutral), implying a risk-adjusted threshold of $248,037/QALY.
  • Respondents showed risk aversion over cognitive impairments (mean RRA=1.49).
  • WTP for mobility impairment prevention was $671.35/year (vs. $133.23 risk-neutral), implying a risk-adjusted threshold of $502,193/QALY.
  • Respondents exhibited risk aversion over mobility impairments (mean RRA=0.68).

Conclusions:

  • Individuals demonstrate significant willingness to pay for treatments mitigating neurological impairments.
  • Patients are risk-averse regarding cognitive and mobility health states.
  • Incorporating risk preferences into cost-effectiveness analyses is essential for accurate valuation of neurological treatments.