The impact of losses in income due to ill health: does the EQ-5D reflect lost earnings?

Two key questions in the context of UK health policy are: do the published preference indices for EQ-5D reflect the impact of lost earnings? Are we currently implicitly including indirect costs in our analyses? It is crucial to investigate whether or not individuals take into account any possible impact of lost income in health state valuation exercises. If respondents do consider income effects, and these considerations change valuations, then these effects would need to be excluded both under the current NICE reference case, or where productivity costs are included in the numerator to avoid double counting. This study adapts the study design used to generate population value sets for EQ-5D, as first used in the Measurement and Valuation of Health (MVH) Study, and carries out valuations of hypothetical EQ-5D states using Time Trade Off (TTO) exercises through an online survey administered in the Netherlands. Furthermore, this study uses a number of different TTO questions to explore the impact of losses in income on the valuation of hypothetical health states, and to determine the relationship between income and health.EQ-5D; time trade-off; health-related loss of income

Measuring the value of life: Exploring a new method for deriving the monetary value of a QALY

Economic evaluations of new health technologies now typically produce an incremental cost per Quality Adjusted Life Year (QALY) value. The QALY is a measure of health benefit that combines length of life with quality of life, where quality of life is assessed on a scale where zero represents a health state equivalent to being dead and one represents full health. The challenge for decision makers, such as the Treasury, is to determine the appropriate size of the healthcare budget. Bodies such as the National Institute for Health and Clinical Excellent (NICE) in the U.K. must then determine how much they can afford to pay for a gain of one QALY, while operating under this fixed budget. While there is no fixed cost-effectiveness threshold and each intervention is assessed on a case by case basis, under normal circumstances the threshold will not be below £20,000 and not above £30,000 per QALY. Recent research has sought to determine the monetary value individuals place on a QALY to inform the size of the healthcare budget and the level of the cost-effectiveness threshold. This research has predominantly used Willingness to Pay (WTP) approaches. However, WTP has a number of known problems, most notably its insensitivity to scope. In this paper we present an alternative approach to estimating the monetary value of a QALY (MVQ), which is based upon a Time Trade Off (TTO) exercise of income with health held constant at perfect health. We present the methods and theory underlying this experimental approach and some results from an online feasibility study in the Netherlands

Welfarism vs. extra-welfarism

'Extra-welfarism' has received some attention in health economics, yet there is little consensus on what distinguishes it from more conventional 'welfarist economics'. In this paper, we seek to identify the characteristics of each in order to make a systematic comparison of the ways in which they evaluate alternative social states. The focus, though this is not intended to be exclusive, is on health. Specifically, we highlight four areas in which the two schools differ: (i) the outcomes considered relevant in an evaluation; (ii) the sources of valuation of the relevant outcomes; (iii) the basis of weighting of relevant outcomes and (iv) interpersonal comparisons. We conclude that these differences are substantive. (C) 2007 Elsevier B.V. All rights reserved

Hope Mediates the Relation between Income and Subjective Well-Being

In this study, we examine whether the positive effect of income gains on subjective well-being (SWB) can in part be explained by the improved future prospects that are generated by a more solid financial situation. Using three-wave panel data from the US, we inspect the relation between changes in income, hope and SWB using a fixed-effects model. Results show that hope indeed partially mediates the relation between income and SWB, but only for monthly incomes over $1800. Positive expectations, on the other hand, mediate the relation for all income levels. From the two components of hope, agency, the belief that we can achieve our goals, seems to be the strongest mediator. We find no indications that extremely high levels of hope or expectations will harm SWB through disappointment

Public Preferences for Introducing a COVID-19 Certificate:A Discrete Choice Experiment in the Netherlands

Objective: Here we investigate public preferences for coronavirus disease 2019 (COVID-19) certificates in the Netherlands, and whether these preferences differ between subgroups in the population. Methods: A survey including a discrete choice experiment was administered to 1500 members of the adult population of the Netherlands. Each participant was asked to choose between hypothetical COVID-19 certificates that differed in seven attributes: the starting date, and whether the certificate allowed gathering with multiple people, shopping without appointment, visiting bars and restaurants, visiting cinemas and theatres, attending events, and practising indoor sports. Latent class models (LCMs) were used to determine the attribute relative importance and predicted acceptance rate of hypothetical certificates. Results: Three classes of preference patterns were identified in the LCM. One class a priori opposed a certificate (only two attributes influencing preferences), another class was relatively neutral and included all attributes in their decision making, and the final class was positive towards a certificate. Respondents aged > 65 years and those who plan to get vaccinated were more likely to belong to the latter two classes. Being allowed to shop without appointment and to visit bars and restaurants was most important to all respondents, increasing predicted acceptance rate by 12 percentage points. Conclusions: Preferences for introduction of a COVID-19 certificate are mixed. A certificate that allows for shopping without appointment and visiting bars and restaurants is likely to increase acceptance. The support of younger citizens and those who plan to get vaccinated seems most sensitive to the specific freedoms granted by a COVID-19 certificate

Public preferences for policies promoting a healthy diet:a discrete choice experiment

BACKGROUND: Worldwide obesity rates have nearly tripled over the past five decades. So far, policies to promote a healthier diet have been less intrusive than those to reduce tobacco and alcohol consumption. Not much is known about public support for policies that aim to promote a healthy diet. In this study, a discrete choice experiment (DCE) was used to elicit stated preferences for policies varying in intrusiveness among a representative sample of the public of The Netherlands. METHODS: The choice tasks presented respondents a hypothetical scenario of two policy packages, each comprising a mix of seven potential policies that differed in level of intrusiveness. We estimated mixed logit models (MXL) to estimate respondents’ preferences for these policies and performed latent class analyses to identify heterogeneity in preferences. RESULTS: The MXL model showed that positive financial incentives like subsidies for vegetables and fruit yielded most utility. A tax of 50% on sugary drinks was associated with disutility while a tax of 20% was associated with positive utility compared to no tax at all. We identified three subgroups with distinct preferences for the seven policies to promote a healthy diet, which were characterized as being “against”, “mixed” and “pro” policies to promote a healthy diet. CONCLUSION: Preferences for policies promoting a healthy diet vary considerably in the Dutch population, particularly in relation to more intrusive policies. This makes selection and implementation of a policy package that has wide public support challenging. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10198-022-01554-7

Some pain, no gain: experiences with the no-claim rebate in the Dutch health care system

To contain expenditures in an increasingly demand driven health care system, in 2005 a no-claim rebate was introduced in the Dutch health insurance system. Since demand-side cost sharing is a very controversial issue, the no-claim rebate was launched as a consumer friendly bonus system to reward prudent utilization of health services. Internationally, the introduction of a mandatory no-claim rebate in a social health insurance scheme is unprecedented. Consumers were entitled to an annual rebate of 255 eruos if no claims were made. During the year, all health care expenses except fo

Your right arm for a publication in AER?

The time tradeoff (TTO) method is popular in medical decision making for valuing health states. We use it to elicit economists’ preferences for publishing in top economic journals and living without limbs. The economists value the journals highly, and have a clear preference between them, with American Economic Review (AER) the most preferred. Their responses imply they would sacrifice more than half a thumb for publishing in AER. The TTO results are consistent with ranking and willingness to pay results, and indicate that preferences for journals are neither guided by influence factors, nor by expectations of a resulting salary rise

Your right arm for a publication in AER?

The time tradeoff (TTO) method is popular in medical decision making for valuing health states. We use it to elicit economists’ preferences for publishing in top economic journals and living without limbs. The economists value the journals highly, and have a clear preference between them, with American Economic Review (AER) the most preferred. Their responses imply they would sacrifice more than half a thumb for publishing in AER. The TTO results are consistent with ranking and willingness to pay results, and indicate that preferences for journals are neither guided by influence factors, nor by expectations of a resulting salary rise