IDEAS home Printed from
   My bibliography  Save this article

Patient and general public preferences for health states: A call to reconsider current guidelines


  • Versteegh, M.M.
  • Brouwer, W.B.F.


In economic evaluations of health care interventions, benefits are often expressed in terms of Quality-Adjusted Life-Years (QALYs). The QALY comprises length and quality of life into one measure which allows cross-disease comparability. The quality adjustment of the QALY is based on preferences for health states. An important normative choice is the question whose preferences for states of health we wish to capture. The answer to this question is directly related to the normative question regarding the appropriate maximand in health care decisions. Currently, preferences are commonly derived from the general public, rather than from actual patients. This choice, which can have large consequences on final outcomes of economic evaluations, has always been a topic of debate. This paper clarifies and furthers the discussion regarding the appropriate source of preferences for health state valuations, acknowledges the plurality of different perspectives, and argues that health economic guidelines could require analysis of benefit in terms of QALYs based on both patient and general public preferences.

Suggested Citation

  • Versteegh, M.M. & Brouwer, W.B.F., 2016. "Patient and general public preferences for health states: A call to reconsider current guidelines," Social Science & Medicine, Elsevier, vol. 165(C), pages 66-74.
  • Handle: RePEc:eee:socmed:v:165:y:2016:i:c:p:66-74
    DOI: 10.1016/j.socscimed.2016.07.043

    Download full text from publisher

    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    1. Brazier, John & Ratcliffe, Julie & Salomon, Joshua & Tsuchiya, Aki, 2016. "Measuring and Valuing Health Benefits for Economic Evaluation," OUP Catalogue, Oxford University Press, edition 2, number 9780198725923.
    2. Paul Dolan & Daniel Kahneman, 2008. "Interpretations Of Utility And Their Implications For The Valuation Of Health," Economic Journal, Royal Economic Society, vol. 118(525), pages 215-234, January.
    3. Koopmanschap, Marc A. & Rutten, Frans F. H. & van Ineveld, B. Martin & van Roijen, Leona, 1995. "The friction cost method for measuring indirect costs of disease," Journal of Health Economics, Elsevier, vol. 14(2), pages 171-189, June.
    4. Burstrom, Kristina & Johannesson, Magnus & Diderichsen, Finn, 2006. "A comparison of individual and social time trade-off values for health states in the general population," Health Policy, Elsevier, vol. 76(3), pages 359-370, May.
    5. Daniel Kahneman & Robert Sugden, 2005. "Experienced Utility as a Standard of Policy Evaluation," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 32(1), pages 161-181, September.
    6. Brouwer, Werner B.F. & Culyer, Anthony J. & van Exel, N. Job A. & Rutten, Frans F.H., 2008. "Welfarism vs. extra-welfarism," Journal of Health Economics, Elsevier, vol. 27(2), pages 325-338, March.
    7. Niklas Zethraeus & Magnus Johannesson, 1999. "A comparison of patient and social tariff values derived from the time trade-off method," Health Economics, John Wiley & Sons, Ltd., vol. 8(6), pages 541-545.
    8. Renske Hoefman & Job Exel & Werner Brouwer, 2013. "How to Include Informal Care in Economic Evaluations," PharmacoEconomics, Springer, vol. 31(12), pages 1105-1119, December.
    9. Harris, Richard & Olewiler, Nancy, 1979. "The Welfare Economics of Ex Post Optimality," Economica, London School of Economics and Political Science, vol. 46(182), pages 137-147, May.
    10. Hadorn, David C., 1991. "The role of public values in setting health care priorities," Social Science & Medicine, Elsevier, vol. 32(7), pages 773-781, January.
    11. Sharma, Rajiv & Stano, Miron & Haas, Mitchell, 2004. "Adjusting to changes in health: implications for cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 23(2), pages 335-351, March.
    12. Karl Claxton & Mike Paulden & Hugh Gravelle & Werner Brouwer & Anthony J. Culyer, 2011. "Discounting and decision making in the economic evaluation of health‐care technologies," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 2-15, January.
    13. McTaggart-Cowan, Helen & Tsuchiya, Aki & O'Cathain, Alicia & Brazier, John, 2011. "Understanding the effect of disease adaptation information on general population values for hypothetical health states," Social Science & Medicine, Elsevier, vol. 72(11), pages 1904-1912, June.
    14. L. M. Lamers & J. McDonnell & P. F. M. Stalmeier & P. F. M. Krabbe & J. J. V. Busschbach, 2006. "The Dutch tariff: results and arguments for an effective design for national EQ-5D valuation studies," Health Economics, John Wiley & Sons, Ltd., vol. 15(10), pages 1121-1132.
    15. Menzel, Paul & Dolan, Paul & Richardson, Jeff & Olsen, Jan Abel, 2002. "The role of adaptation to disability and disease in health state valuation: a preliminary normative analysis," Social Science & Medicine, Elsevier, vol. 55(12), pages 2149-2158, December.
    16. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
    Full references (including those not matched with items on IDEAS)


    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Thesis Thursday: David Mott
      by Chris Sampson in The Academic Health Economists' Blog on 2019-04-18 06:00:33


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Ogorevc, Marko & Murovec, Nika & Fernandez, Natacha Bolanos & Rupel, Valentina Prevolnik, 2019. "Questioning the differences between general public vs. patient based preferences towards EQ-5D-5L defined hypothetical health states," Health Policy, Elsevier, vol. 123(2), pages 166-172.
    2. John Brazier & Donna Rowen & Milad Karimi & Tessa Peasgood & Aki Tsuchiya & Julie Ratcliffe, 2018. "Experience-based utility and own health state valuation for a health state classification system: why and how to do it," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(6), pages 881-891, July.
    3. Engel, Lidia & Bryan, Stirling & Noonan, Vanessa K. & Whitehurst, David G.T., 2018. "Using path analysis to investigate the relationships between standardized instruments that measure health-related quality of life, capability wellbeing and subjective wellbeing: An application in the ," Social Science & Medicine, Elsevier, vol. 213(C), pages 154-164.
    4. Cubi-Molla, P. & Mott, D. & Shah, K. & Herdman, M. & Summers, Y. & Devlin, N., 2018. "Quality of Life in Long-term Cancer Survivors: Implications for Future Health Technology Assessments in Oncology," Consulting Reports 002023, Office of Health Economics.
    5. de Hond, Anne & Bakx, Pieter & Versteegh, Matthijs, 2019. "Can time heal all wounds? An empirical assessment of adaptation to functional limitations in an older population," Social Science & Medicine, Elsevier, vol. 222(C), pages 180-187.


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:165:y:2016:i:c:p:66-74. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Haili He). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.