title: Are some QALYs more equal than others?
abstract: Including societal preferences in allocation decisions is an important challenge for the health care sector. Here, we present results of a phased discrete choice experiment investigating the impact of various attributes on respondents' preferences for distribution of health and health care. In addition to the renowned equity principles severity of illness (operationalized as initial health) and fair innings (operationalized as age), some characteristics of beneficiaries (culpability and having dependents) and the disease (rarity) were included in the choice experiment. We used a nested logit model to analyse the data. We found that all selected attributes significantly influenced respondents' choices. The phased inclusion showed that additional attributes affected respondents' preferences for previously-included attributes and reduced unobserved variance. Although not all these attributes may be considered relevant for decision making from a normative perspective, including them in choice experiments contributes to our understanding of societal preferences for each single attribute.
authors.affiliation: Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, DR, 3000, The Netherlands. vandewetering@bmg.eur.nl.
authors.forename: E J
authors.initials: EJ
authors.lastname: van de Wetering
authors.affiliation: Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, DR, 3000, The Netherlands.
authors.forename: N J A
authors.initials: NJ
authors.lastname: van Exel
authors.affiliation: Institute of Transport and Logistics Studies, The University of Sydney, Sydney, Australia.
authors.forename: J M
authors.initials: JM
authors.lastname: Rose
authors.affiliation: Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, DR, 3000, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: Hoefman
authors.affiliation: Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, DR, 3000, The Netherlands.
authors.forename: W B F
authors.initials: WB
authors.lastname: Brouwer
mesh_terms: D000328:Adult; D000368:Aged; D002755:Choice Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D057240:Patient Preference; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D040841:Resource Allocation / Q000379:methods; D011795:Surveys and Questionnaires
keywords: Discrete choice experiment; Equity; Healthcare decision making; Societal preferences