Does Society Place Special Value on End of Life Treatments?
There is a growing body of empirical evidence that members of the general public are willing to sacrifice aggregate health gains in order to direct resources towards those who are worst off in terms of the severity of their condition. This implies that the social value of a QALY accruing to a severely ill patient is greater than that of a QALY accruing to a patient who is not severely ill. A number of studies have examined whether the social value of a QALY varies according to how the QALYs are distributed, the characteristics of the patients receiving the QALYs or the characteristics of the health effect itself. This chapter describes the policy context in relation to the social value of a QALY in the UK, focusing on the way in which NICE appraises life-extending end of life treatments. It presents a summary of recent UK and non-UK studies examining priority-setting preferences regarding end of life treatments, before noting some of the discussion points arising from the evidence and finishing with recommendations for future research.
KeywordsNational Health Service Discrete Choice Experiment Life Extension Short Life Expectancy Appraisal Committee
I am grateful for the contributions of Aki Tsuchiya and Allan Wailoo, who provided comments on draft versions of this book chapter. I would also like to thank Rachel Baker, Mark Pennington, Jose Luis Pinto Prades and Chris Skedgel for their suggestions and clarifications.
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