title: Comparing Increments in Utility of Health: An Individual-based Approach.
abstract: Many economic evaluations of health care changes rely on quality-adjusted life year (QALY) estimates. Notably, though, the QALY approach values health states rather than changes in health states. Hence, a gain in utility of health is only indirectly valued through an ex ante preference elicitation of health states and the subsequent subtraction of health state values from one another, rather than being valued directly. There is therefore an underlying assumption that individuals, from an ex ante perspective ceteris paribus, would be indifferent between equal utility increments from health states with different baseline utilities.
  
  
  
  The aim of this paper is to develop a method that would allow us to measure individual-based preferences over utility increments from different baselines. We elicit our data using face-to-face interviews on a sample of UK individuals.
  
  
  
  Overall, we find that gains of "equal" utility increments from different baselines are not found to be equally preferable by the individual.
  
  
  
  The results indicate that the subtraction approach could lead to sub-optimal resource allocations and suggest that a new approach which values health changes directly would better reflect individual preferences. This paper provides the foundations for a method to achieve this.
authors.affiliation: York Health Economics Consortium, University of York, York, North Yorkshire, UK. Electronic address: matthew.taylor@york.ac.uk.
authors.forename: Matthew
authors.initials: M
authors.lastname: Taylor
authors.affiliation: Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Chilton
authors.affiliation: York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ronaldson
authors.affiliation: Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: Metcalf
authors.affiliation: Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK.
authors.forename: Jytte Seested
authors.initials: JS
authors.lastname: Nielsen
mesh_terms: D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D057240:Patient Preference / Q000706:statistics & numerical data; D036301:Qualitative Research; D019057:Quality-Adjusted Life Years; D006113:United Kingdom
keywords: QALY; quality of life; stated preference; utility