Polinder Suzanne, Meerding Willem Jan, van Exel Job, Brouwer Werner
Department of Public Health, Erasmus MC/University Medical Centre, Rotterdam, The Netherlands.
Pharmacoeconomics. 2005;23(8):791-802. doi: 10.2165/00019053-200523080-00005.
Increasing life expectancy and decreasing marginal valuation of additional QALYs over time may serve as a basis for discounting future health effects from a societal perspective. Therefore, we tested the hypothesis that societal time preference for health is related to perceived future life expectancy.
A sample of 223 people from the general population prioritised healthcare programmes with differential timing of health benefits and costs from a societal perspective. Furthermore, we asked respondents to estimate future life expectancy.
The relationship between future life expectancy and time preference for health is ambiguous. We observed that people who expected a higher future life expectancy elicited higher discount rates for health effects than those with lower life expectancy growth expectations for all four time periods (5, 10, 20 and 40 years into the future), but the differences were never significant. On average, providing explicit information on growth in life expectancy did significantly alter discount rates in the expected direction but, on an individual level, the results were rather inconsistent. We observed a significantly stronger time preference (i.e. higher discount rates) for health effects than for costs. As commonly observed, discount rates for health and money decreased with time delay following a hyperbolic function.
Our data indicate that it is troublesome to elicit societal discount rates empirically, especially rates that are in line with the theoretical arguments on societal discounting. The influence of life expectancy remains ambiguous, but there seems to be at least some positive relationship between growth in life expectancy and discount rates that deserves additional attention.
随着时间推移，预期寿命的增加以及额外质量调整生命年（QALY）边际价值的降低，可能构成从社会角度对未来健康影响进行贴现的基础。因此，我们检验了这样一个假设，即社会对健康的时间偏好与感知到的未来预期寿命相关。
从普通人群中抽取223人作为样本，从社会角度对具有不同健康效益和成本时间安排的医疗保健项目进行优先级排序。此外，我们要求受访者估计未来预期寿命。
未来预期寿命与健康时间偏好之间的关系不明确。我们观察到，对于所有四个时间段（未来5年、10年、20年和40年），预期未来预期寿命较高的人对健康影响的贴现率高于预期寿命增长预期较低的人，但差异均不显著。平均而言，提供关于预期寿命增长的明确信息确实显著地朝着预期方向改变了贴现率，但在个体层面上，结果相当不一致。我们观察到，对健康影响的时间偏好（即较高的贴现率）明显强于对成本的时间偏好。正如通常所观察到的，健康和金钱的贴现率随着时间延迟呈双曲线函数下降。
我们的数据表明，通过实证得出社会贴现率很困难，尤其是得出与社会贴现理论观点相符的贴现率。预期寿命的影响仍然不明确，但预期寿命增长与贴现率之间似乎至少存在一些积极关系，值得进一步关注。
