IDEAS home Printed from
   My bibliography  Save this paper

Drop Dead: Is Anchoring at 'Dead' a Theoretical Requirement in Health State Valuation?


  • Sampson, C.
  • Parkin, D.
  • Devlin, N.


By convention, values for generic 'preference-based' measures, such as the EQ-5D, are anchored at 1 = full health and 0 = dead. This paper challenges the assumption that anchoring health state values at 'dead = 0' is a necessary condition for values to be used in quality-adjusted life year (QALY) estimation. The authors consider five propositions, using narrative review of the literature and conceptual explication of the problem - - anchoring at 'dead' is not required by theories of scale measurement and utility; - calculating QALY gains does not require a distinction between states better than and worse than dead; - cost-effectiveness analysis does not require that 'dead' has a value relative to health states; - using 'dead' as an anchor causes problems that make studies difficult to conduct and their results difficult to interpret; and - there are alternative states to 'dead' that exhibit favourable properties for anchoring. There is support for each proposition. Anchoring health state values at dead was an arbitrary choice made early in the development of health state valuation methods. The use of dead as an anchor is unnecessary and undesirable because of the methodological and conceptual issues it causes. The authors conclude that, in valuing health states, researchers should 'drop dead'.

Suggested Citation

  • Sampson, C. & Parkin, D. & Devlin, N., 2020. "Drop Dead: Is Anchoring at 'Dead' a Theoretical Requirement in Health State Valuation?," Research Papers 002308, Office of Health Economics.
  • Handle: RePEc:ohe:respap:002308

    Download full text from publisher

    File URL:
    Download Restriction: no

    More about this item


    Measuring and Valuing Outcomes;

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health

    NEP fields

    This paper has been announced in the following NEP Reports:


    Access and download statistics


    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:ohe:respap:002308. 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: (Publications Manager). 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.

    We have no references for this item. You can help adding them by using 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.