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Valuing health at the end of life: an empirical study of public preferences


  • Koonal Shah


  • Aki Tsuchiya


  • Allan Wailoo



In 2009, the National Institute for Health and Clinical Excellence (NICE) issued supplementary advice to its Appraisal Committees to be taken into account when appraising life-extending, ‘end-of-life’ treatments. This indicated that if certain criteria are met, it may be appropriate to recommend the use of such treatments even if they would not normally be considered cost-effective. However, NICE’s public consultation revealed concerns that there is little scientific evidence to support such a policy. This study examines whether there is public support for giving higher priority to life-extending, end-of-life treatments than to other types of treatment. In face-to-face interviews, respondents answered six questions asking them to choose which of two hypothetical patients they would prefer to treat, assuming that the health service has enough funds to treat one but not both of them. The various scenarios were designed so as to control for age- and time-related preferences. Fifty members of the general public in England were interviewed in July 2011. We find some evidence of support for giving priority to the patient with shorter remaining life expectancy, but note that a nontrivial minority of respondents expressed the opposite preference. Substantial preference for quality-of-life improvement over life extension was observed. Very few respondents expressed indifference or unwillingness to choose between the patients. Whilst there cannot be described to be a single ‘consensus’ set of preferences, we conclude that there are ways in which the results suggest that the current NICE policy may be insufficient. Copyright Springer-Verlag Berlin Heidelberg 2014

Suggested Citation

  • Koonal Shah & Aki Tsuchiya & Allan Wailoo, 2014. "Valuing health at the end of life: an empirical study of public preferences," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(4), pages 389-399, May.
  • Handle: RePEc:spr:eujhec:v:15:y:2014:i:4:p:389-399
    DOI: 10.1007/s10198-013-0482-3

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    References listed on IDEAS

    1. Shah, Koonal K., 2009. "Severity of illness and priority setting in healthcare: A review of the literature," Health Policy, Elsevier, vol. 93(2-3), pages 77-84, December.
    2. Emily Lancsar & Jordan Louviere, 2008. "Conducting Discrete Choice Experiments to Inform Healthcare Decision Making," PharmacoEconomics, Springer, vol. 26(8), pages 661-677, August.
    3. Pinto-Prades, Jose-Luis & Sánchez-Martínez, Fernando-Ignacio & Corbacho, Belen & Baker, Rachel, 2014. "Valuing QALYs at the end of life," Social Science & Medicine, Elsevier, vol. 113(C), pages 5-14.
    4. Paul Dolan & Rebecca Shaw & Aki Tsuchiya & Alan Williams, 2005. "QALY maximisation and people's preferences: a methodological review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 197-208.
    5. Shah, K. & Tsuchiya, A. & Wailoo, A., 2011. "Valuing Health at the End of Life: An Exploratory Preference Elicitation Study," Research Papers 000172, Office of Health Economics.
    6. Richardson, Jeff & McKie, John, 2005. "Empiricism, ethics and orthodox economic theory: what is the appropriate basis for decision-making in the health sector?," Social Science & Medicine, Elsevier, vol. 60(2), pages 265-275, January.
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    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Thesis Thursday: Koonal Shah
      by Chris Sampson in The Academic Health Economists' Blog on 2017-11-16 13:00:09


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    Cited by:

    1. Pinto-Prades, Jose-Luis & Sánchez-Martínez, Fernando-Ignacio & Corbacho, Belen & Baker, Rachel, 2014. "Valuing QALYs at the end of life," Social Science & Medicine, Elsevier, vol. 113(C), pages 5-14.
    2. Shah, Koonal K. & Tsuchiya, Aki & Wailoo, Allan J., 2015. "Valuing health at the end of life: A stated preference discrete choice experiment," Social Science & Medicine, Elsevier, vol. 124(C), pages 48-56.
    3. McHugh, Neil & van Exel, Job & Mason, Helen & Godwin, Jon & Collins, Marissa & Donaldson, Cam & Baker, Rachel, 2018. "Are life-extending treatments for terminal illnesses a special case? Exploring choices and societal viewpoints," Social Science & Medicine, Elsevier, vol. 198(C), pages 61-69.
    4. S. Olofsson & U.-G. Gerdtham & L. Hultkrantz & U. Persson, 2018. "Measuring the end-of-life premium in cancer using individual ex ante willingness to pay," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(6), pages 807-820, July.
    5. Nikki McCaffrey & Simon Eckermann, 2018. "Raise the Bar, Not the Threshold Value: Meeting Patient Preferences for Palliative and End-of-Life Care," PharmacoEconomics - Open, Springer, vol. 2(2), pages 93-95, June.
    6. Gu, Yuanyuan & Lancsar, Emily & Ghijben, Peter & Butler, James RG & Donaldson, Cam, 2015. "Attributes and weights in health care priority setting: A systematic review of what counts and to what extent," Social Science & Medicine, Elsevier, vol. 146(C), pages 41-52.
    7. Hansen, Lise Desireé & Kjær, Trine, 2019. "Disentangling public preferences for health gains at end-of-life: Further evidence of no support of an end-of-life premium," Social Science & Medicine, Elsevier, vol. 236(C), pages 1-1.
    8. Franken, Margreet & Stolk, Elly & Scharringhausen, Tessa & de Boer, Anthonius & Koopmanschap, Marc, 2015. "A comparative study of the role of disease severity in drug reimbursement decision making in four European countries," Health Policy, Elsevier, vol. 119(2), pages 195-202.
    9. McHugh, Neil & Pinto-Prades, José Luis & Baker, Rachel & Mason, Helen & Donaldson, Cam, 2020. "Exploring the relative value of end of life QALYs: Are the comparators important?," Social Science & Medicine, Elsevier, vol. 245(C).
    10. Shah, Koonal K. & Tsuchiya, Aki & Wailoo, Allan J., 2018. "Valuing health at the end of life: A review of stated preference studies in the social sciences literature," Social Science & Medicine, Elsevier, vol. 204(C), pages 39-50.
    11. Erdem, Seda & Campbell, Danny & Thompson, Carl, 2014. "Addressing elimination and selection by aspects decision rules in discrete choice experiments: does it matter?," 2014 Annual Meeting, July 27-29, 2014, Minneapolis, Minnesota 169839, Agricultural and Applied Economics Association.
    12. Kleinhout-Vliek, Tineke & de Bont, Antoinette & Boer, Bert, 2017. "The bare necessities? A realist review of necessity argumentations used in health care coverage decisions," Health Policy, Elsevier, vol. 121(7), pages 731-744.

    More about this item


    UK; End of life; NICE; Distributional preferences; Severity; I18;

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health


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