Abstract
BackgroundThe use of preference-elicitation tasks for valuing health states is well established, but little is known about whether these preferences are informed. Preferences may not be informed because individuals with little experience of ill health are asked to value health states. The use of uninformed preferences in cost-effectiveness can result in sub-optimal resource allocation. The aim of this study was to pilot a novel method to assess whether members of the public are informed about health states they value in preference-elicitation tasks.MethodsThe general public was said to be informed if the expectations of the public about the effect of ill health on people’s lives were in agreement with the experience of patients. Sixty-two members of the public provided their expectations of the consequences of ill health on five life domains (activities, enjoyment, independence, relationships, and avoiding being a burden). A secondary dataset was used to measure patient experience on those five consequences.ResultsThere were differences between the expectations of the public and the experience of patients. For example, for all five life consequences the public underestimated the effects of problems in usual activities compared to problems in mobility. They also underestimated the effect of ‘anxiety or depression’ compared to physical problems on enjoyment of life and on the quality of personal relationships.ConclusionsThis proof-of-concept study showed that it is possible to test whether preferences are informed. This study should be replicated using a larger sample. The findings suggest that preferences over health states in this sample are not fully informed because the participants do not have accurate expectations about the consequences of ill health. These uninformed preferences may not be adequate for allocation of public resources, and research is needed into methods to make them better informed.
Highlights
The use of preference-elicitation tasks for valuing health states is well established, but little is known about whether these preferences are informed
The National Institute for Health and Care Excellence (NICE) in England recommends the use of a preferences-based tariff of the EQ-5D health instrument [4] in cost-effectiveness analysis
Previous empirical work has shown that there is some evidence that members of the Karimi et al Health and Quality of Life Outcomes (2017) 15:105 general public overestimate the effect of some health problems on subjective well-being (SWB) [7] and have difficulty assessing the effect of adaptation [8]
Summary
The use of preference-elicitation tasks for valuing health states is well established, but little is known about whether these preferences are informed. The National Institute for Health and Care Excellence (NICE) in England recommends the use of a preferences-based tariff of the EQ-5D health instrument [4] in cost-effectiveness analysis. It is Despite suggestions in the literature about the need for informed preferences, it is not clear what individuals should be informed about and how to test whether preferences are informed. Previous empirical work has shown that there is some evidence that members of the Karimi et al Health and Quality of Life Outcomes (2017) 15:105 general public overestimate the effect of some health problems on subjective well-being (SWB) [7] and have difficulty assessing the effect of adaptation [8]. The authors are not aware of a literature on whether members of the general public are informed about the wider consequences of the health states they are valuing
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