Medical Decision Making (MDM)
July–August 2012; 32 (4)
http://mdm.sagepub.com/content/current
Theme: Patients’ Choices: Perceived Risk, Health State Values, and Decisions

Valuing Health: A Brief Report on Subjective Well-Being versus Preferences
Paul Dolan and Robert Metcalfe
Med Decis Making July–August 2012 32: 578-582, first published on February 2, 2012 doi:10.1177/0272989X11435173

Extract
Health care can improve people’s quality of life, and it can help them live longer. The quality-adjusted-life-years (QALYs) approach has been developed to express these twin components of benefit (quality and quantity of life) in a single number. It expresses different health states on a scale between 0 for death and 1 for full health and then multiplies these values by how long the states last. One QALY is equivalent to 1 year of life in full health.1 By comparing how many QALYs different interventions are expected to generate with how much those interventions are expected to cost, it is possible to show the cost-effectiveness of different uses of resources.

In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) recommends that “the value of changes in patients’ health related quality of life should be based on public preferences using a choice-based method . . . [and] the EQ-5D is the preferred measure of HRQL in adults.”2 The EQ-5D™ defines health in terms of 1 of 3 levels of severity (broadly, no problems, some problems, and extreme problems) associated with each of 5 dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression). Each of the 243 (35) health states are represented by a 5-digit code, ranging from 11111 for full health to 33333 for extreme problems on all 5 dimensions. Values for these states have been elicited by asking members of the public for their time tradeoff (TTO) preferences, that is, to state how many years of life in 11111 they consider to be equivalent to a longer period of time in one of the remaining 242 “poor” health states.3,4

There is a long tradition of asking for people’s preferences over future, hypothetical prospects. 5,6 It is also not without its …