The European Journal of Health Economics

, Volume 15, Issue 4, pp 389–399 | Cite as

Valuing health at the end of life: an empirical study of public preferences

  • Koonal K. Shah
  • Aki Tsuchiya
  • Allan J. Wailoo
Original Paper


In 2009, the National Institute for Health and Clinical Excellence (NICE) issued supplementary advice to its Appraisal Committees to be taken into account when appraising life-extending, ‘end-of-life’ treatments. This indicated that if certain criteria are met, it may be appropriate to recommend the use of such treatments even if they would not normally be considered cost-effective. However, NICE’s public consultation revealed concerns that there is little scientific evidence to support such a policy. This study examines whether there is public support for giving higher priority to life-extending, end-of-life treatments than to other types of treatment. In face-to-face interviews, respondents answered six questions asking them to choose which of two hypothetical patients they would prefer to treat, assuming that the health service has enough funds to treat one but not both of them. The various scenarios were designed so as to control for age- and time-related preferences. Fifty members of the general public in England were interviewed in July 2011. We find some evidence of support for giving priority to the patient with shorter remaining life expectancy, but note that a nontrivial minority of respondents expressed the opposite preference. Substantial preference for quality-of-life improvement over life extension was observed. Very few respondents expressed indifference or unwillingness to choose between the patients. Whilst there cannot be described to be a single ‘consensus’ set of preferences, we conclude that there are ways in which the results suggest that the current NICE policy may be insufficient.


UK End of life NICE Distributional preferences Severity 

JEL Classification




This article is based on work funded by the National Institute for Health and Clinical Excellence through its Decision Support Unit. The views, and any errors or omissions, expressed in this article are of the authors only. We are grateful for the contributions of Meindert Boysen, John Brazier, Bérengère Davin, Simon Dixon, Jenny Dunn, Karen Gerard, Arne Risa Hole, Jonathan Michaels, Bhash Naidoo, Janet Robertson, Andrew Stevens, Aurélia Tison and Rebecca Trowman. We would also like to thank all of the respondents who took part in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Koonal K. Shah
    • 1
    • 2
  • Aki Tsuchiya
    • 2
    • 3
  • Allan J. Wailoo
    • 2
  1. 1.Office of Health EconomicsLondonUK
  2. 2.School of Health and Related ResearchUniversity of SheffieldSheffieldUK
  3. 3.Department of EconomicsUniversity of SheffieldSheffieldUK

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