Domain-specific discounting of health and money: implications for health technology assessment

This study aims to measure the pure time preference of the Chinese population in the monetary and health domains, to explore potential domain differences and factors influencing individual discounting, and to provide empirical evidence to address controversies regarding the discounting of costs and health outcomes in health technology assessment.

We defined health outcomes as health states and life years separately. A cross-sectional survey was designed. Face-to-face questionnaires were conducted with residents across 24 Chinese provinces. Indifference points of respondents at different delay scenarios were elicited through an iterative choice procedure. We analyzed the data with multilevel linear mixed-effects models.

The final sample comprised 533 respondents, showing that pure time preferences for monetary outcomes are significantly higher than those for quality of life and life years. No significant difference in discounting was found between the health outcomes of health states and life years. For all three experimental scenes, estimated discount rates declined significantly as the delay increased. Higher educational attainment was associated with lower discount rates in both domains. The effects of income, age, and other covariates on discount rates were also domain-specific.

Our study finds that individuals have significant domain-specific differences in pure time preferences for money and health. Such evidence may have implications for the discounting of costs and health benefits in HTA and help develop discounting rules that better reflect the social time preference perspective and inform health decision-making.