The Person-trade-off Approach to Valuing Health Care Programs

Abstract

The person-trade-off technique is a way of estimating the social values of different health care interventions. Basically it consists in asking people how many outcomes of one kind they consider equivalent in social value to X outcomes of another kind. The paper outlines a number of the author's previous studies using the technique. The studies suggest that while the technique is theoretically appealing for resource-allocation purposes, it is in practice quite demanding. It needs to be applied in fairly large groups of subjects to keep random measurement error at an acceptable level. Possible framing effects include the effects of argument presentation and the choice of start points in numerical exercises. To control for these effects, it seems important to take subjects through a multistep procedure, in which they are induced to carefully consider the various arguments that might be relevant in each exercise and to reconsider initial responses in the light of their implications. The investigator must also think through which decision context he or she wishes to study and make his or her choice of context very clear when reporting the results. In spite of these problems, the person-trade-off technique deserves greater attention in the field of cost-utility analysis.

Measuring the health of populations: the veil of ignorance approach

“…In such a way DALYs would be a better instrument to inform resource allocation decisions [5]. As it is claimed that the PTO can encapsulate social preferences [6] it was the method finally chosen. .…”

Theory of constraints for publicly funded health systems

“…al. (1993), and Nord (1995. For the sake of our conceptual model, a unit of measurement is needed that captures both quality gains and quantity gains of life.…”

Valuing the benefits and costs of health care programmes: where's the ‘extra’ in extra-welfarism?

“…However, WE approaches are not confined to measuring individuals' values of the quantity of health improvement. Instead individuals' preferences among alternative programmes have been found to be sensitive to, inter alia, the ex ante levels of health (Nord, 1994;Nord, Richardson, & Macarounas-Kirchmann, 1993;Nord, Richardson, Street, Kuhse, & Singer, 1995a, b) and the processes used to deliver services (Cairns & Shackley, 1996;Birch et al, 1998). If the relevant set of characteristics are to be determined under a WE framework (i.e., justified on the basis of what is in the utility function) this implies that health improvement is merely one possible candidate for that set.…”