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Lookup NU author(s): Professor Cam Donaldson,
Dr Rachel Baker,
Emeritus Professor Michael Jones-Lee,
Dr Emily Lancsar,
Professor Graham Loomes,
Dr Helen Mason,
Dr Philip Shackley,
Professor John WildmanORCiD
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Since the inception of the National Institute for Health and Clinical Excellence (NICE) there have been questions about whether quality adjusted life years (QALYs) gained by different beneficiaries of health care should be weighted equally and the feasibility of estimating a monetary value of a QALY. The studies reported in this document, had three aims: • to identify characteristics of beneficiaries of health care over which relative weights should be derived; • to estimate relative weights to be attached to health gains according to characteristics of recipients of these gains; and • to assess the feasibility of estimating a willingness-to-pay-based value of a QALY. In-depth qualitative work and considerations of policy relevance resulted in the identification of age and severity of illness as relevant characteristics. Scenarios reflecting these, along with additional components reflecting gains in QALYs, were presented to respondents in a series of pairwise choices using two types of question: discrete choice and matching. The survey was administered to a nationally-representative sample (of 587) of the population in England by the National Centre for Social Research (NatCen) during February-April 2007. Discrete choice results show age and severity variables did not have a strong impact on respondents’ choices over and above the health (QALY) gains presented. In contrast, matching showed age and severity impacts to be strong: depending on method of aggregation, gains to some groups being weighted 3 to 11 times more highly than gains to others. The valuation study was conducted on a smaller convenience sample (409). Respondents were asked about their willingness-to-pay (WTP) to avoid/prevent different durations of headache or stomach illness and to value these states on a scale (death=0; full health=1) using standard gamble (SG) questions. Results from the WTP and SG questions were combined in different ways to arrive at values of a QALY. These vary from values which are in the vicinity of the current NICE threshold to extremely high values. Results are preliminary. More research is required to explore methodological differences with respect to age and severity weighting. On valuation, there are particular issues concerning the extent to which ‘noise’ and ‘error’ in people’s responses might generate extreme and unreliable figures. Methods of aggregation and measures of central tendency were issues in both weighting and valuation procedures and require further exploration.
Author(s): Donaldson C, Baker R, Bateman I, Jones-Lee M, Lancsar E, Loomes G, Mason H, Odejar M, Prades JLP, Robinson A, Ryan M, Shackley P, Smith R, Sugden R, Wildman J
Publication type: Report
Publication status: Published
Institution: The SVQ Research Team