Advertisement

The European Journal of Health Economics

, Volume 18, Issue 6, pp 671–683 | Cite as

How important is severity for the evaluation of health services: new evidence using the relative social willingness to pay instrument

  • Jeff Richardson
  • Angelo Iezzi
  • Aimee Maxwell
Original Paper

Abstract

The ‘severity hypothesis’ is that a health service which increases a patient’s utility by a fixed amount will be valued more highly when the initial health state is more severe. Supporting studies have employed a limited range of analytical techniques and the objective of the present paper is to test the hypothesis using a new methodology, the Relative Social Willingness to Pay. Three subsidiary hypotheses are: (1) that the importance of the ‘severity effect’ varies with the type of medical problem; (2) that the relationship between value and utility varies with the severity of the initial health state; and (3) that there is a threshold beyond which severity effects are insignificant. For each of seven different health problems respondents to a web-based survey were asked to allocate a budget to five services which would, cumulatively, move a person from near death to full health. The time trade-off utilities of health states before and after the service were estimated. The social valuation of the service measured by the budget allocation was regressed upon the corresponding increase in utility and severity as measured by the pre-service health state utility. Results confirm the severity hypothesis and support the subsidiary hypotheses. However, the effects identified are quantitatively significant only for the most severe health states. This implies a relatively limited redistribution of resources from those with less severe to those with more severe health problems.

Keywords

CEA Severity Social preferences Social value 

Notes

Acknowledgments

Financial support for this study was provided entirely by a grant from the National Health and Medical Research Council (NH&MRC) project Grant ID 1069241. Measuring health related social preferences and their inclusion in an alternative formula for prioritising health services.

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest.

Supplementary material

10198_2016_817_MOESM1_ESM.pdf (499 kb)
Supplementary material 1 (PDF 499 kb)

References

  1. 1.
    Shah, K.K.: Severity of illness and priority setting in healthcare: a review of the literature. Health Policy 93, 77–84 (2009)CrossRefPubMedGoogle Scholar
  2. 2.
    Gu, Y., Lancsar, E., Ghijben, P., Butler, J., Donaldson, C.: Attributes and weights in health care priority setting: a systematic review of what counts and to what extent. Soc. Sci. Med. 146, 41–52 (2015). doi: 10.1016/j.socscimed.2015.10.005 CrossRefPubMedGoogle Scholar
  3. 3.
    Tsuchiya, A., Dolan, P., Shaw, R.: Measuring people’s preferences regarding ageism in health: some methodological issues and some fresh evidence. Soc. Sci. Med. 57(4), 687–696 (2003)CrossRefPubMedGoogle Scholar
  4. 4.
    Diederich, A.J., Swait, J., Wirsik, N.: Citizen participation in patient prioritization policy decisions: an emprical and experimental study on patients’ characteristics. PLoS One 7(5), e36824 (2012)CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Nord, E., Johansen, R.: Transforming EQ-5D utilities for use in cost-value analysis of health programs. Eur J Health Econ (2014). doi: 10.1007/s10198-014-0576-6 Google Scholar
  6. 6.
    Nord, E., Johansen, R.: Concerns for severity in priority setting in health care: a review of trade-off data in preference studies and implications for societal willingness to pay for a QALY. Health Policy 116(2), 281–288 (2014)CrossRefPubMedGoogle Scholar
  7. 7.
    Lancsar, E., Wildman, J., Donaldson, C., Ryan, M., Baker, R.: Deriving distributional weights for QALYs through discrete choice experiments. J Health Econ 30, 466–478 (2011)CrossRefPubMedGoogle Scholar
  8. 8.
    Dolan, P., Shaw, R., Tsuchiya, A., Williams, A.: QALY maximisation and people’s preferences: a methodological review of the literature. Health Econ. 14(2), 197–208 (2005)CrossRefPubMedGoogle Scholar
  9. 9.
    Ubel, P.: How stable are people’s preferences for giving priority to severely ill patients? Soc. Sci. Med. 49(7), 895–903 (1999)CrossRefPubMedGoogle Scholar
  10. 10.
    Richardson, J., Iezzi, A., Sinha, K., Khan, M.A., McKie, J.: An instrument for measuring the relative social willingness to pay for health state improvement. Health Econ. 23, 792–805 (2013)CrossRefPubMedGoogle Scholar
  11. 11.
    Drummond, M., Sculpher, M., Torrance, G., O’Brien, B., Stoddart, G.: Methods for the economic evaluation of health care programs, 3rd edn. Oxford University Press, Oxford (2005)Google Scholar
  12. 12.
    Richardson, J., Sinha, K., Iezzi, A., Khan, M.A.: Modelling utility weights for the Assessment of Quality of Life (AQoL) 8D. Qual. Life Res. 23(8), 2395–2404 (2014). doi: 10.1007/s11136-014-0686-8 CrossRefPubMedGoogle Scholar
  13. 13.
    Torrance, G., Feeny, D., Furlong, W., Barr, R., Zhang, Y., Wang, Q.: Multiattribute utility function for a comprehensive health status classification system: health utilities index mark II. Med. Care 34(7), 702–722 (1996)CrossRefPubMedGoogle Scholar
  14. 14.
    Feeny, D., Furlong, W., Torrance, G., Goldsmith, C., Zhu, Z., DePauw, S., Denton, M., Boyle, M.: Multi attribute and single attribute utility functions for the Health Utilities Index Mark 3 System. Med. Care 40(2), 113–128 (2002)CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Centre for Health Economics, Monash Business SchoolMonash UniversityClaytonAustralia

Personalised recommendations