Valuing health at the end of life: A stated preference discrete choice experiment

Shah, Koonal; Tsuchiya, Aki; Wailoo, Allan

doi:10.1016/j.socscimed.2014.11.022

Cited by 70 publications

(79 citation statements)

References 26 publications

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“…Rowen et al () present LEs of between 3 months and 5 years and find a preference for EOL treatment (defined as LE ≤ 2 years). Shah et al () operate with similar LEs (3 to 60 months, also with a cutoff at 2 years) but find no support for an EOL premium. In Shah et al (), the trade‐off involves 1 versus 10 years of remaining LE, and the authors find weak evidence of preference for EOL treatment.…”

Section: Introductionmentioning

confidence: 99%

Is there additional value attached to health gains at the end of life? A revisit

Gyrd‐Hansen

2017

Health Economics

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Researchers have in recent years sought to establish whether the general public value treatment at the end of life (EOL) more highly than other treatments. Results are mixed, with social preferences most often exhibiting lack of preferences for EOL treatments. This null result may be driven by the often applied study design, where respondents are to choose between treatments targeting patients with varying fixed life expectancies. When remaining life is certain and salient, a rule-of-rescue sentiment may drive preferences across all scenarios. This study presents a different design, where the comparator is a preventive intervention. We study preferences from both an individual and social perspective and find no preference for an EOL premium.

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Section: Introductionmentioning

confidence: 99%

Is there additional value attached to health gains at the end of life? A revisit

Gyrd‐Hansen

2017

Health Economics

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“…The evidence, however, remains limited and equivocal. Shah et al [4], Olsen [5] and Linley and Hughes [6] find no, or limited, support for an end of life premium. In contrast, Pinto-Prades et al [7], Pennington et al [8], Shah et al [9] and Rowen et al [10] find evidence suggestive of an end of life premium.…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, Pinto-Prades et al [7], Pennington et al [8], Shah et al [9] and Rowen et al [10] find evidence suggestive of an end of life premium. These studies have taken quantitative approaches, including discrete choice survey methods [4,10], person or benefit trade-off questions [6,7] and willingness to pay (WTP) [7,8]. …”

Section: Introductionmentioning

confidence: 99%

Extending life for people with a terminal illness: a moral right and an expensive death? Exploring societal perspectives

et al. 2015

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BackgroundMany publicly-funded health systems apply cost-benefit frameworks in response to the moral dilemma of how best to allocate scarce healthcare resources. However, implementation of recommendations based on costs and benefit calculations and subsequent challenges have led to ‘special cases’ with certain types of health benefits considered more valuable than others. Recent debate and research has focused on the relative value of life extensions for people with terminal illnesses. This research investigates societal perspectives in relation to this issue, in the UK.MethodsQ methodology was used to elicit societal perspectives from a purposively selected sample of data-rich respondents. Participants ranked 49 statements of opinion (developed for this study), onto a grid, according to level of agreement. These ‘Q sorts’ were followed by brief interviews. Factor analysis was used to identify shared points of view (patterns of similarity between individuals’ Q sorts).ResultsAnalysis produced a three factor solution. These rich, shared accounts can be broadly summarised as: i) ‘A population perspective – value for money, no special cases’, ii) ‘Life is precious – valuing life-extension and patient choice’, iii) ‘Valuing wider benefits and opportunity cost - the quality of life and death’.From the factor descriptions it is clear that the main philosophical positions that have long dominated debates on the just allocation of resources have a basis in public opinion.ConclusionsThe existence of certain moral positions in the views of society does not ethically imply, and pragmatically cannot mean, that all are translated into policy. Our findings highlight normative tensions and the importance of critically engaging with these normative issues (in addition to the current focus on a procedural justice approach to health policy). Future research should focus on i) the extent to which these perspectives are supported in society, ii) how respondents' perspectives relate to specific resource allocation questions, and iii) the characteristics of respondents associated with each perspective.

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“…In particular, NICE saw political interference in its process from the UK Department of Health when it was asked to introduce ‘end‐of‐life criteria’ that would enable it to approve sunitinib for patients with advanced kidney cancer. The apparent arbitrariness of some of the criteria imposed on NICE (and now assimilated into its guidance) was confirmed in empirical work by NICE's own Decision Support Unit that cast doubt on whether the general public did put extra value on health outcomes achieved at the end of life (Shah et al ., ). Nevertheless, the principle that there could be other factors beyond cost‐effectiveness that should influence decision‐making began to be seriously explored.…”

mentioning

confidence: 97%

“…criteria imposed on NICE (and now assimilated into its guidance) was confirmed in empirical work by NICE's own Decision Support Unit that cast doubt on whether the general public did put extra value on health outcomes achieved at the end of life (Shah et al, 2015). Nevertheless, the principle that there could be other factors beyond cost-effectiveness that should influence decision-making began to be seriously explored.…”

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confidence: 99%

A View from the Bridge: Health Economic Evaluation — A Value‐Based Framework?

Briggs

2016

Health Economics

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In the 25 years since Health Economics first came to press, health economic evaluation has come of age. The first issue of Health Economics was published in 1992, the same year that the Pharmaceutical Benefits Advisory Committee in Australia launched its first formal submission process for manufacturers to gain listing on its pharmaceutical benefit schedule, which included the requirement to present an economic assessment of the drug's cost-effectiveness. Within the next few years, Canada had followed with its Common Drug Review and the UK introduced the National Institute for Clinical Excellence (NICE) in 1999. These early attempts to implement formal health technology assessment (HTA) processes into national decision-making have all stood the test of time, and many other countries have followed suit, with processes in Germany, Sweden and the Netherlands all employing a formal assessment of value (O'Donnell et al., 2009). The proliferation of national processes is gaining traction in other parts of the world too, with many countries in South America and Asia developing their own guidelines and submission processes. Even Japan has entered the fray with a new HTA programme that began on a trial basis from April of this year.Although the US was an early pioneer of HTA with its Office of Technology Assessment (OTA), the US remains one part of the world where there is relatively little formal use of health economic evaluation. This gap can in part be explained by the disparate group of payers that makes up the US system. Without a 'single-payer' model, the impetus for a national programme of HTA is lacking. Indeed, the OTA was disbanded in the US in 1995 just as other HTA systems were finding their mark (O'Donnell et al., 2009). Even where national bodies still exist, their ability to consider cost-effectiveness information is restricted. For example, the US Preventive Services Task Force (USPSTF) is not allowed to consider cost when issuing its guidance -a bizarre situation that leads investigators to use healthcare resource use as a proxy for cost when examining efficiency in screening programmes. The recent USPSTF guidance on colorectal cancer screening used 'colonoscopy' procedures as its measure of resource cost in order to estimate an efficiency frontier for different screening options (Knudsen et al., 2016). Likewise, in order to get the Affordable Care Act through congress, an amendment required that the Patient-Centered Outcomes Research Institute (PCORI) be prevented from using cost per quality-adjusted life year (QALY) thresholds for prioritizing healthcare deliveryeffectively outlawing cost-effectiveness analysis (Neumann and Weinstein, 2010). PCORI's own frequently asked questions page even emphasizes that proposals that include direct comparisons of the costs of care between two or more alternative interventions will not be considered for funding.Although the processes in Australia, Canada and the UK have largely survived unchanged over the past 15-20 years, there have been some challenges. In particul...

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Valuing health at the end of life: A stated preference discrete choice experiment

Cited by 70 publications

References 26 publications

Is there additional value attached to health gains at the end of life? A revisit

Is there additional value attached to health gains at the end of life? A revisit

Extending life for people with a terminal illness: a moral right and an expensive death? Exploring societal perspectives

A View from the Bridge: Health Economic Evaluation — A Value‐Based Framework?

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