Should patients have a greater role in valuing health states?
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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).
KeywordsResponse Shift Standard Gamble General Population Sample Full Health Resource Allocation Decision
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.
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