de Vries Linda M, Brouwer Werner B F, van Baal Pieter H M
Erasmus School of Health Policy and Management, Department of Health Economics, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
Eur J Health Econ. 2024 Oct 7. doi: 10.1007/s10198-024-01726-7.
Adopting a societal perspective in cost-effectiveness analysis (CEA) requires including all societal costs and benefits even if they fall outside of the realm of health and healthcare. While some benefits are not explicitly included, they might be implicitly included when people value quality-adjusted life-years (QALYs) in monetary terms. An example is utility of consumption (UoC) which has played a crucial role in discussions regarding the welfare economic underpinnings of CEA. This study investigates whether people consider elements beyond health when valuing QALYs monetarily and the influence of inclusion on this value. A Willingness to Pay (WTP) experiment was administered among the general public in which people were asked to assign monetary values to QALYs. Our results show that (stated) UoC increases with quality of life but that instructing people to consider UoC does not impact their monetary valuation of the QALY. Furthermore, many respondents consider elements beyond health when valuing QALYs but the impact on the monetary value of a QALY is limited. These findings suggest that these elements are currently not (adequately) captured in CEA. Findings also illustrate that it is difficult to isolate health from non-health benefits and to consistently capture these in CEA. With that, reconciling CEA with welfare economics remains challenging.
在成本效益分析（CEA）中采用社会视角要求纳入所有社会成本和收益，即便它们超出了健康和医疗保健领域。虽然有些收益未被明确纳入，但当人们以货币形式评估质量调整生命年（QALY）时，它们可能会被隐含地纳入。一个例子是消费效用（UoC），它在关于CEA的福利经济基础的讨论中发挥了关键作用。本研究调查了人们在以货币形式评估QALY时是否会考虑健康以外的因素以及纳入这些因素对该价值的影响。在普通公众中进行了一项支付意愿（WTP）实验，要求人们为QALY赋予货币价值。我们的结果表明，（所述的）UoC随生活质量提高，但指示人们考虑UoC并不会影响他们对QALY的货币估值。此外，许多受访者在评估QALY时会考虑健康以外的因素，但对QALY货币价值的影响有限。这些发现表明，目前CEA中并未（充分）涵盖这些因素。研究结果还表明，很难将健康与非健康收益区分开来并在CEA中始终如一地体现这些收益。因此，使CEA与福利经济学相协调仍然具有挑战性。
