title: Comparing WTP values of different types of QALY gain elicited from the general public.
abstract: BACKGROUND
  The appropriate thresholds for decisions on the cost-effectiveness of medical interventions remain controversial, especially in 'end-of-life' situations. Evidence of the values placed on different types of health gain by the general public is limited.
  
  
  METHODS
  Across nine European countries, 17,657 people were presented with different hypothetical health scenarios each involving a gain of one quality adjusted life year (QALY) and asked about their willingness to pay (WTP) for that gain. The questions included quality of life (QoL) enhancing and life extending health gains, and a scenario where respondents faced imminent, premature death.
  
  
  RESULTS
  The mean WTP values for a one-QALY gain composed of QoL improvements were modest (PPP$11,000). When comparing QALY gains obtained in the near future, the valuation of life extension exceeded the valuation of QoL enhancing gains (mean WTP PPP$19,000 for a scenario in which a coma is avoided). The mean WTP values were higher still when respondents faced imminent, premature death (PPP$29,000).
  
  
  CONCLUSIONS
  Evidence from the largest survey on the value of health gains by the general public indicated a higher value for life extending gains compared with QoL enhancing gains. A further modest premium may be indicated for life extension when facing imminent, premature death.
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Pennington
authors.forename: Rachel
authors.initials: R
authors.lastname: Baker
authors.forename: Werner
authors.initials: W
authors.lastname: Brouwer
authors.forename: Helen
authors.initials: H
authors.lastname: Mason
authors.forename: Dorte Gyrd
authors.initials: DG
authors.lastname: Hansen
authors.forename: Angela
authors.initials: A
authors.lastname: Robinson
authors.forename: Cam
authors.initials: C
authors.lastname: Donaldson
mesh_terms: D003362:Cost-Benefit Analysis; D003657:Decision Making; D005060:Europe; D005382:Financing, Personal / Q000706:statistics & numerical data*; D006801:Humans; D017059:Models, Econometric; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires
keywords: EuroVaQ; contingent valuation; willingness-to-pay