title: Valuing QALYs in Relation to Equity Considerations Using a Discrete Choice Experiment.
abstract: BACKGROUND
  To judge whether an intervention offers value for money, the incremental costs per gained quality-adjusted life-year (QALY) need to be compared with some relevant threshold, which ideally reflects the monetary value of health gains. Literature suggests that this value may depend on the equity context in which health gains are produced, but the value of a QALY in relation to equity considerations has remained largely unexplored.
  
  
  OBJECTIVE
  The objective of this study was to estimate the social marginal willingness to pay (MWTP) for QALY gains in different equity subgroups, using a discrete choice experiment (DCE). Both severity of illness (operationalized as proportional shortfall) and fair innings (operationalized as age) were considered as grounds for differentiating the value of health gains.
  
  
  METHODS
  We obtained a sample of 1205 respondents, representative of the adult population of the Netherlands. The data was analysed using panel mixed multinomial logit (MMNL) and latent class models.
  
  
  RESULTS
  The panel MMNL models showed counterintuitive results, with more severe health states reducing the probability of receiving treatment. The latent class models revealed distinct preference patterns in the data. MWTP per QALY was sensitive to severity of disease among a substantial proportion of the public, but not to the age of care recipients.
  
  
  CONCLUSIONS
  These findings emphasize the importance of accounting for preference heterogeneity among the public on value-laden issues such as prioritizing health care, both in research and decision making. This study emphasises the need to further explore the monetary value of a QALY in relation to equity considerations.
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, 3000 DR, Rotterdam, The Netherlands. vandewetering@bmg.eur.nl.
authors.forename: Liesbet
authors.initials: L
authors.lastname: van de Wetering
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, 3000 DR, Rotterdam, The Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van Exel
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, 3000 DR, Rotterdam, The Netherlands.
authors.forename: Ana
authors.initials: A
authors.lastname: Bobinac
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, 3000 DR, Rotterdam, The Netherlands. brouwer@bmg.eur.nl.
authors.forename: Werner B F
authors.initials: WB
authors.lastname: Brouwer
mesh_terms: D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics*; D004194:Disease / Q000191:economics*; D006801:Humans; D018803:Models, Economic; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index