title: Valuing QALYs at the end of life.
abstract: The possibility of weighting QALYs differently for different groups of patients has been a source of debate. Most recently, this debate has been extended to the relative value of QALYs at the end of life (EoL). The objective of this study is to provide evidence of societal preferences in relation to this topic. Three cross-sectional surveys were conducted amongst Spanish general population (n = 813). Survey 1 compared increases in life expectancy for EoL patients with health gains from temporary health problems. Survey 2 compared health gains for temporary health problems with quality of life gains at the EoL (palliative care). Survey 3 compared increases in life expectancy with quality of life gains, both for EoL patients. Preferences were elicited using Person Trade-Off (PTO) and Willingness to pay (WTP) techniques presenting two different durations of health benefit (6 and 18 months). Health benefits, measured in QALYs, were held constant in all comparisons. In survey 1 mean WTP was higher for life extending treatments than for temporary health problems and the majority of respondents prioritised life extension over temporary health problems in response to the PTO questions. In survey 2 mean WTP was higher for palliative care than for temporary health problems and 83% prioritized palliative care (for both durations) in the PTO questions. In survey 3 WTP values were higher for palliative care than for life extending treatments and more than 60% prioritized palliative care in the PTO questions. Our results suggest that QALYs gained from EoL treatments have a higher social value than QALYs gained from treatments for temporary health problems. Further, we found that people attach greater weight to improvements in quality of life than to life extension at the end of life.
authors.affiliation: Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK; University Pablo de Olavide, Sevilla, Spain. Electronic address: joseluis.pintoprades@gmail.com.
authors.forename: Jose-Luis
authors.initials: JL
authors.lastname: Pinto-Prades
authors.affiliation: University of Murcia, Spain.
authors.forename: Fernando-Ignacio
authors.initials: FI
authors.lastname: Sánchez-Martínez
authors.affiliation: Department of Health Sciences, University of York, UK.
authors.forename: Belen
authors.initials: B
authors.lastname: Corbacho
authors.affiliation: Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Baker
mesh_terms: D000328:Adult; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D005382:Financing, Personal; D006801:Humans; D008017:Life Expectancy / Q000639:trends; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012945:Social Values; D013030:Spain; D026712:Value of Life
keywords: End of life; Life extension; Palliative care; Person trade-off; QALY weights; Spain; Willingness to pay