Severity as an independent determinant of the social value of a health service

Abstract

This paper has two objectives, first to review the relevant literature concerning the social importance of severity of pre-treatment condition, and second to present the results of a new analysis of the relationship between social value, individual assessment of health improvement and the severity of illness. The present study differs methodologically from others reported in the literature. The underlying hypothesis is that members of the public have an aversion to patients being in a severe health state irrespective of the reason for their being there, and that this aversion will affect the social valuation of a health program after taking account of the magnitude of the health improvement. This effect will be observable in a program which (compared to another) takes a person out of a severe health state--the usual case discussed in the literature--or in a program which (compared to another) leaves a person in a severe health state. The present study tests this second implication of the hypothesis. We present data consistent with the view that after taking account of health improvement, health programs are preferred which do not leave people in severe health states. Alternative explanations are considered and particularly the possibility that data reflect a social preference for individuals achieving their health potential. Both explanations imply the need to reconsider the rules for prioritizing programs. In this analysis, Person Trade-Off (PTO) scores are used to measure social preferences ('value' or 'social utility') and Time Trade-Off (TTO) scores are used to measure individual assessments of health improvement and initial severity. Econometric results suggest that severity is highly significant and may more than double the index of social value of a health service.

Lifetime QALY prioritarianism in priority setting

“…In this field, the worse off are also typically defined in terms of health, as opposed to advantage more generally ii . So defined, support for priority to the worse off—together with a concern for the greater benefit—pervades both public opinion and official health policy 7 11–15. Prioritarianism may thus be seen as a nexus for priority setting in health.…”

An Instrument for Measuring the Social Willingness to Pay for Health State Improvement

“…A potential source of bias in most other instruments is the assumption that the value of a service is equal to the difference between the value of the initial and subsequent health states. The evidence relating to the importance of the severity of the initial health state, as distinct from the size of the improvement, casts some doubt upon this assumption (Nord, ; Richardson et al ., ). Along with the PTO, the RS‐WTP avoids this problem by measuring the value of change from an initial health state.…”

A comparative study of the role of disease severity in drug reimbursement decision making in four European countries

“…For example, published information can explain that because of the high levels of severity (e.g., remaining life expectancy of 6 months), the absolute gain of two months in life expectancy is acceptable. Policymakers may (re)consider the use of additional HTA evidence; for example, evidence derived from the disease severity concepts, and/or evidence from multi criteria decision analysis (MCDA) including evidence from obtained (public) preferences (e.g., social value of the QALY [14][15][16], preferences for severity of illness [10,17,18], end-of-life treatment [19,20]). This may help to improve consistency in their deliberations and increase the legitimacy of their decision-making process.…”

“…Velasco-Garrido et al [7] found the 'need' aspect to be one of the most considered criteria in nine European countries. Similarly, other studies eliciting policymakers' preferences [12,13], or by eliciting public preferences regarding the social value of the quality adjusted life year (QALY) [14][15][16], preferences for severity of illness [10,17,18], for end-of-life treatment [19,20], or for the rule-of-rescue [21]. These studies provided insights into the (relative) importance of the severity of the disease.…”