No abstract

It is a well-established fact that many people view the prospect of premature death by some causes with considerably more disquiet or “dread” than death by other causes. It is equally clear that for most people their personal risk of death by a given cause is also a matter of serious concern. This article reports the findings of a study aimed at estimating the effects of dread and personal risk of death by a specific cause on the willingness-to-pay based Value of Statistical Life (VSL) for that cause. Copyright Springer Science + Business Media, LLC 2006Dread, Willingness to pay, Value of Statistical Life,

: Recently, for many health economics researchers, empirical estimation of the monetary valuation of a quality-adjusted life year (QALY) has become an important endeavour. Different philosophical and practical approaches to this have emerged. On the one hand, there is a view that, with health-care budgets set centrally, decision-making bodies within the system can iterate, from observation of a series of previous decisions, towards the value of a QALY, thus searching for such a value. Alternatively, and more consistent with the approach taken in other public sectors, individual members of the public are surveyed with the aim of directly eliciting a preference-based -also known as a willingness-to-pay-based (WTP-based) -value of a QALY. While the former is based on supply-side factors and the latter on demand, both in fact suffer from informational deficiencies. Sole reliance on either would necessitate an acceptance or accommodation of chronic inefficiencies in health-care resource allocation. On the basis of this observation, this paper makes the case that in order to approach optimal decision making in health-care provision, a framework incorporating and thus, to a degree, reconciling these two approaches is to be preferred.

We propose a structural relationship between the value of preventing a statistical cancer fatality and the value of statistical life (VSL) for risks of an instantaneous road accident fatality. This relationship incorporates a context effect reflecting both the illness or 'morbidity' associated with cancer fatality and the 'dread' or horror associated with the prospect of eventual death from cancer, as well as a latency effect that captures the discounting likely to arise because the onset of the symptoms of cancer typically occurs after some delay. We use a Risk-Risk trade-off study to validate this model by directly estimating the influence of context and latency effects upon the relative size of the VSL for cancer and for road accidents, confirming that both effects are significant and estimating their size using regression analysis. We show that morbidity accounts for the majority of the context premium. We use the elicited coefficients to reconstruct VSL estimates for a range of cancers characterised by their latency and morbidity periods.

Value of statistical life, Incentivised learning, Distribution of life expectancy gains, J17, D6,