The impact of a belief in life after death on health-state preferences: True difference or artifact?

Abstract

Purpose

In most religions, the preservation of one’s own, God-given, life is considered obligatory, while the time trade-off method (TTO) forces one to voluntarily forego life years. We sought to verify how this conflict impacts TTO-results among the religious.

Methods

We used the data from the only EQ-5D valuation in Poland (2008, three-level, 321 respondents, 23 states each)—a very religious, mostly Catholic country. We measured the religiosity with the belief in afterlife question on two levels: strong (definitely yes) and some (also rather yes), both about a third of the sample.

Results

The religious more often are non-traders, unwilling to give up any time in exchange for quality of life: odds ratio (OR) equal to 1.97 (strong religiosity), OR 1.55 (some religiosity); and less often consider a state worse than death: OR 0.67 (strong), OR 0.81 (some). These associations are statistically significant (\(p^*<0.001\)) and hold when controlling for possible demographic confounders. Strong religiosity abates the utility loss: in the additive approach by 0.14, in the multiplicative approach by the factor of 2.1 (both \(p^*<0.001\)), especially among the older. Removing the effect of religiosity from the value set reduces the utility by 0.05 on average.

Conclusion

The results may stem from a true difference in preferences or be a TTO-artifact and would vanish for other elicitation methods. Juxtaposing our findings with comments from respondents in other studies suggests the latter. Therefore, this Weltanschauung effect should be removed in cost–utility analysis.

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Notes

  1. 1.

    And for several years, EQ-5D-5L has been being developed [24].

  2. 2.

    Using so many states in the valuation process was shown not to cause any problems [19, 20].

  3. 3.

    Provocatively, one might then say that this disappearance may be an artifact. It seems highly improbable, however, for an elicitation technique to exactly offset the true difference in preferences.

  4. 4.

    Personal e-mail correspondence with K. Rand-Hendriksen, University of Oslo, a co-author of the [5] study.

  5. 5.

    We are a bit informal, as no expected value can be calculated in the space of health states; but the intuition is, hopefully, clear.

  6. 6.

    The elicitation method much closer to how the values are then used is the person-trade-off (PTO), in which benefits in various groups of patients are compared; PTO is difficult in practice, e.g. due to fragility to framing [28, 29], and not popular in practice [focusing on health gains might make the result depend on the reference point, see Nord et al. [4].

  7. 7.

    We only used a crude definition, compare, e.g. [18].

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Acknowledgments

A substantial part of work was done during M. Jakubczyk’s visit at The University of Iowa, thanks to the Fulbright Senior Award. We appreciate the comments during the EuroQol Group Annual Meeting 2015, after the discussion started by H. Bailey; nevertheless, the views expressed here do not necessarily reflect these of the EuroQol Group. The paper has greatly benefited from the remarks of two anonymous reviewers.

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Correspondence to Michał Jakubczyk.

Appendix

Appendix

See Table 4.

Table 4 Comparison of means (traders only) and variations (all) between strong believers and the others

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Jakubczyk, M., Golicki, D. & Niewada, M. The impact of a belief in life after death on health-state preferences: True difference or artifact?. Qual Life Res 25, 2997–3008 (2016). https://doi.org/10.1007/s11136-016-1356-9

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Keywords

  • Health-related quality of life
  • Utility
  • Preference elicitation
  • Time trade-off
  • Religion
  • Life after death