The societal monetary value of a QALY associated with EQ-5D-3L health gains


There is an extensive body of empirical research that focuses on the societal monetary value of a quality-adjusted life year (MVQALY). Many of these studies have found the estimates to be inversely associated with the size of the health gain, and thus not conforming to the linearity assumption imposed in the QALY model. In this study, we explore the extent to which the MVQALY varies when it is associated with different types and magnitudes of quality of life (QoL) improvements. To allow for a comprehensive assessment, we derive the MVQALY corresponding to the full spectrum of health gains defined by the EQ-5D-3L instrument. The analysis was based on a large and representative sample of the population in Spain. A discrete choice experiment and a time trade-off exercise were used to derive a value set for utilities, followed by a willingness to pay questionnaire. The data were jointly analysed using regression analyses and bootstrapping techniques. Our findings indicate that societal values for a QALY corresponding to different EQ-5D-3L health gains vary approximately between 10,000€ and 30,000€. MVQALY associated with larger improvements on QoL was found to be lower than that associated with moderate QoL gains. The potential sources of the observed non-constant MVQALY are discussed.

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We want to thank Juan Manuel Ramos Goñi and Marcel Minke for their support with the survey design and implementation. We are very grateful to Juan Oliva Moreno, Fernando I. Sánchez Martínez and Eva M. Rodríguez Míguez for their comments on previous versions of this paper. We also want to thank all the researchers, health professionals and health economists that reviewed our survey, as well as all the participants that completed our questionnaire.


This work was undertaken in the framework of activities run by the Network of Health Technology Assessment Agencies, funded by the Ministry of Health, Social Services and Equality in Spain.

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Correspondence to Laura Vallejo-Torres.

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Appendix 1: Questionnaire (selected sections)

Section A: Respondents’ health status


Section B: Discrete choice experiment


Section C: Willingness to pay


Section D: Time trade-off


Appendix 2: Choice set


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Vallejo-Torres, L., García-Lorenzo, B., Rivero-Arias, O. et al. The societal monetary value of a QALY associated with EQ-5D-3L health gains. Eur J Health Econ 21, 363–379 (2020).

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  • Willingness to pay
  • Quality-adjusted life year
  • Social perspective
  • EQ-5D

JEL Classification

  • D61
  • I10
  • I18