Applied Health Economics and Health Policy

, Volume 4, Issue 4, pp 201–208 | Cite as

Should patients have a greater role in valuing health states?

  • John BrazierEmail author
  • Ron Akehurst
  • Alan Brennan
  • Paul Dolan
  • Karl Claxton
  • Chris McCabe
  • Mark Sculpher
  • Aki Tsuchyia
Current Opinion


Currently, health state values are usually obtained from members of the general public trying to imagine what the state would be like rather than by patients who are actually in the various states of health. Valuations of a health state by patients tend to vary from those of the general population, and this seems to be due to a range of factors including errors in the descriptive system, adaptation to the state and changes in internal standards. The question of whose values are used in cost-effectiveness analysis is ultimately a normative one, but the decision should be informed by evidence on the reasons for the differences. There is a case for obtaining better informed general population preferences by providing more information on what it is like for patients (including the process of adaptation).


Response Shift Standard Gamble General Population Sample Full Health Resource Allocation Decision 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors would like to acknowledge the comments received from a discussant and other colleagues at the joint CES/HESG Meeting, Paris, France, 2004. The UK MRC HSRC funds John Brazier. John Brazier, Ron Akehurst, Karl Claxton, Chris McCabe and Mark Sculpher were members of the NICE Economics task force.


  1. 1.
    National Institute for Clinical Excellence. Guide to the methods of technology appraisal. London: National Institute for Clinical Excellence, 2003Google Scholar
  2. 2.
    Gold MR, Siegel JE, Russell LB, et al., editors. Cost-effectiveness in health and medicine. Oxford: Oxford University Press, 1996Google Scholar
  3. 3.
    Torrance G, Blaker D, Detsky A, et al. Canadian guidelines for economic evaluation of pharmaceuticals: Canadian Collaborative Workshop for Pharmacoeconomics. Pharmacoeconomics 1996; 9(6): 535–59PubMedCrossRefGoogle Scholar
  4. 4.
    Dolan P. Modelling valuation for EuroQOL health states. Med Care 1997; 35: 351–63CrossRefGoogle Scholar
  5. 5.
    Feeny DH, Furlong WJ, Torrance GW, et al. Multiattribute and single-attribute utility function the Health Utility Index mark 3 system. Med Care 2002; 40(2): 113–28PubMedCrossRefGoogle Scholar
  6. 6.
    Brazier J, Roberts J, Deverill M. The estimation a preference-based single index measure for health from the SF-36. J Health Econ 2002; 21(2): 271–92PubMedCrossRefGoogle Scholar
  7. 7.
    Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford Medical Publications, 1997Google Scholar
  8. 8.
    Sackett DL, Torrance GW. The utility of different health states as perceived by the general public. J Chronic Dis 1978; 31: 697–704PubMedCrossRefGoogle Scholar
  9. 9.
    Froberg DG, Kane RL. Methodology for measuring health-state preferences: II. Scaling methods. J Clin Epidemiol 1989; 42: 459–71PubMedCrossRefGoogle Scholar
  10. 10.
    Boyd NF, Sutherland HJ, Heasman ZK, et al. Whose values for decision making? Med Decis Making 1990; 10: 58–67PubMedCrossRefGoogle Scholar
  11. 11.
    Llewellyn-Thomas H, Sutherland HJ, Tibshirani R, et al. The measurement of patients’ values in medicine. Med Decis Making 1982; 2: 449–62PubMedCrossRefGoogle Scholar
  12. 12.
    Hurst NP, Jobanputra P, Hunter M, et al. Validity of Euroqol: a generic health status instrument: in patients with rheumatoid arthritis. Economic and Health Outcomes Research Group. Br J Rheumatol 1994; 33: 655–62PubMedCrossRefGoogle Scholar
  13. 13.
    Dolan P, Roberts J. To what extent can we explain time trade-off values from other information about respondents? Soc Sci Med 1999; 54: 919–29CrossRefGoogle Scholar
  14. 14.
    Shaw J, Johnson JA, Coons SJ. US valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med Care 2005; 43(3): 203–20PubMedCrossRefGoogle Scholar
  15. 15.
    Dolan P. The effect of age on health state valuations. J Health Serv Res Policy 2000; 5: 17–21PubMedGoogle Scholar
  16. 16.
    Insinga RP, Fryback DG. Understanding differences between self-ratings and population ratings for health in the EuroQOL. Qual Life Res 2003 Sep; 12(6): 611–9PubMedCrossRefGoogle Scholar
  17. 17.
    Kind P, Dolan P, Gudex C, et al. Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ 1998; 316(7133): 736–41PubMedCrossRefGoogle Scholar
  18. 18.
    Ubel PA, Loewenstein G, Jepson C. Whose quality of life? A commentary exploring discrepancies between health state evaluations of patients and the general public. Qual Life Res 2003; 12: 599–607PubMedCrossRefGoogle Scholar
  19. 19.
    Spranger AG, Schwartz CE. Integrating response shift into health-related quality of life research: a theoretical model. Soc Sci Med 1999; 48: 1507–15CrossRefGoogle Scholar
  20. 20.
    Kahneman D, Snell J. Predicting utility. In: Hogarth RAM, editor. Insights in decision making. Chicago (IL): University of Chicago Press, 1990: 295–310Google Scholar
  21. 21.
    Redelmeier DA, Rozin P, Kahneman D. Understanding patients’ decisions: cognitive and emotional perspectives. JAMA 1993; 270(1): 72–6PubMedCrossRefGoogle Scholar
  22. 22.
    Menzel P, Dolan O, Richardson J, et al. The role of adaptation to disability and disease in health state valuation: a preliminary normative analysis. Soc Sci Med 2002; 55(12): 2149–58PubMedCrossRefGoogle Scholar
  23. 23.
    Kahneman D. Experienced utility and objective happiness: a moment based approach. In: Kahneman D, Tversky A, editors. Choices, values, and frames. Cambridge: Cambridge University Press, 2000: 673–93Google Scholar
  24. 24.
    Buckingham K. A note on HYE (healthy years equivalent). J Health Econ 1993; 12: 301–9PubMedCrossRefGoogle Scholar
  25. 25.
    Culyer AJ. Commodities, characteristics of commodities, characteristics of people, utilities and quality of life. In: Baldwin S, Godfrey C, Propper C, editors. The quality of life: perspectives and policies. London: Routledge, 1989: 9–27Google Scholar
  26. 26.
    Culyer AJ. The normative economics of health care finance and provision. Ox Rev Econ Policy 1989; 5(1): 34–58CrossRefGoogle Scholar
  27. 27.
    Richardson J. Cost-utility analysis: what should be measured. Soc Sci Med 1994; 39: 7–21PubMedCrossRefGoogle Scholar
  28. 28.
    Gafni A. Willingness to pay as a measure of benefits: relevant questions in the context of public decision making about health care programmes. Med Care 1991; 29: 1246–52PubMedCrossRefGoogle Scholar
  29. 29.
    Litva A, Coast J, Donovan J, et al. The public is too subjective: public involvement at different levels of health-care decision making. Soc Sci Med 2002; 54: 1825–37PubMedCrossRefGoogle Scholar
  30. 30.
    Fryback DG. Whose quality of life? Or whose decision? Qual Life Res 2003; 12: 609–10PubMedCrossRefGoogle Scholar
  31. 31.
    Lenert LA, Treadwell JR, Schwartz EC. Associations between health status and utilities: implications for policy. Med Care 2001;37(5): 470–89Google Scholar
  32. 32.
    Kahneman D, Tversky A. Prospect theory: an analysis of decision under risk. Econometrica 1979; 47: 263–91CrossRefGoogle Scholar
  33. 33.
    Ariely D, Carmon Z. Gestalt characteristics of experiences: the defining features of summarized events. J Behav Decis Making 2000; 13: 191–201CrossRefGoogle Scholar
  34. 34.
    Kahneman D, Fredrickson BL, Schreiber CA, et al. When more pain is preferred to less: adding a better end. Psychol Sci 1993; 4: 401–5CrossRefGoogle Scholar
  35. 35.
    Torrance GW. Measurement of health state utilities for economic appraisal: a review. J Health Econ 1986; 5: 1–30PubMedCrossRefGoogle Scholar
  36. 36.
    Brazier J, Green C, McCabe C, et al. A review of VAS in economic evaluation. J Pharmacoeconomics Outcomes Res 2003; 3: 293–302CrossRefGoogle Scholar
  37. 37.
    Lundberg L, Johannesson M, Isacson DG, et al. The relationship between health state utilities and the SF-12 in a general population. Med Decis Making 1999; 19: 128–40PubMedCrossRefGoogle Scholar
  38. 38.
    Mann R. A comparison of patient and general population values for EQ5D health states. Sheffield: University of Sheffield, 2005Google Scholar
  39. 39.
    Mukuria CW. Exploring the relationship between health and happiness: a comparison across studies of different conditions using the SF-36 and EQ-5D. Sheffield: University of Sheffield, 2005Google Scholar
  40. 40.
    Aballéa S, Tsuchiya A. Seeing and doing: feasibility study towards valuing visual impairment using simulation spectacles, Sheffield Health Economics Group Discussion Paper, 2004 [online]. Available from URL: [Accessed 2006 Jan 11]
  41. 41.
    Ryan M, Scott DA, Reeves C, et al. Eliciting public preferences for healthcare: a systematic review of techniques. Health Technol Assess 2001; 5(5): 1–186PubMedGoogle Scholar
  42. 42.
    Slovic P. The construction of preferences. Am Psychol 1995; 50(5): 364–71CrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • John Brazier
    • 1
    Email author
  • Ron Akehurst
    • 1
  • Alan Brennan
    • 1
  • Paul Dolan
    • 1
  • Karl Claxton
    • 2
  • Chris McCabe
    • 1
  • Mark Sculpher
    • 2
  • Aki Tsuchyia
    • 1
  1. 1.Health Economics and Decision ScienceThe University of Sheffield, Regent CourtSheffieldUK
  2. 2.Centre for Health EconomicsUniversity of YorkYorkUK

Personalised recommendations