Person tradeoffs and the problem of risk

Abstract

Recently, the person tradeoff method has received much attention because it directs one to value health improvements of those other than one's self. As a result, several researchers have suggested that the person tradeoff measures preferences in pharmaceutical and health economic analysis more accurately than the standard gamble, which many consider the gold standard approach. However, the person tradeoff exercise as it is currently practiced assumes a riskless world where policy decisions lead to certain societal outcomes. In reality, health policy decisions are made under risk or uncertainty. Evidence suggests riskless and risky values differ for health improvements over persons. A problem with using the riskless person tradeoff method in economic evaluation of health is that the method conflates a change in the objects of measurement (i.e., a change from health gains with respect to self to gains with respect to others) with a change in the measurement context (i.e., a change from a risk context to a risk-free one). Therefore, it is wise to examine what is sacrificed by ignoring risk and uncertainty inherent in health policy decision making. Given that the choices we make in the context of risk are often different than those we make under certainty, the authors argue that if one assumes context is important, the measurement of health improvements over persons should then be carried out in the context of risk. The authors propose the application of standard methods from utility theory to carry out elicitations for valuing health improvements of others within the context of risky choices. In addition, an alternative perspective of utility is discussed that in comparison puts forth a context free notion of utility.

Equity Weights for Priority Setting in Healthcare: Severity, Age, or Both?

“…30,33 They may also have considered the acceptability of a less than perfect health state at an older age, the degree of health inequality between the groups, and the risk or uncertainty associated with severity levels and treatment gains. [43][44][45][46] A third limitation concerns a possible upward bias of the PTO ratios caused by censoring the number of patients between 100 and 1 000 000 in the PTO tasks. 47 However, the influence of censoring may be counterbalanced by including respondents with no preference for either of the groups in the analysis as the robustness checks indicated that the obtained ratios were in fact pulled downward by this.…”

When are person tradeoffs valid?

“…This means that the respondent makes decisions between two alternatives that deliver health state improvements to a cohort with certainty. However, it is clear that health policy decisions inherently involve risk or uncertainty (Doctor & Miyamoto, 2005). We know, for example, that policy makers face uncertainty as to the number of persons who will be afflicted with disease or injury in any given year.…”