Departures from health universalism? A value set of AP-7D in Japan as an attempt to develop a "culture-specific"...

Health universalists believe that preference-based measure (PBM) instruments can be applied across cultures because they share similar health concepts in the world. This is the prevailing policy in PBM development. However, health pluralists refute this idea, as they argue that the concept and components of health differ depending on culture. To incorporate the pluralist view, we developed the Asian Preference-Based Measure-7 Dimensions (AP-7D), a "culture-specific" PBM for Asian countries. This survey aimed to address cultural differences in utility measurement by developing an AP-7D value set in Japan, as part of a series of AP-7D developments. This study used a web-based survey to evaluate AP-7D health states with a triplet discrete choice experiment (DCE). The design followed an established international protocol. We conducted the web-based survey and data collection in October 2024. Respondents aged 20-79 were recruited via quota sampling based on sex and age. A total of 2681 individuals were included in the DCE analysis. We applied a mixed logit model to the DCE data and obtained decrements for each level in each domain. The worst health state had an AP-7D value of -0.448. Pain/discomfort, mobility, and burden to others were the most influential items on AP-7D values. Only one non-monotonicity were observed. Our survey successfully created the first AP-7D culture-specific PBM value set, and we can convert responses to AP-7D value for QALY calculation. We believe that our pluralistic approach is a novel and important attempt to reconsider health universalism and inform the future development of PBMs.