Is the value of a life or life-year saved context specific? Further evidence from a discrete choice experiment

BACKGROUND: A number of recent findings imply that the value of a life saved, life-year (LY) saved or quality-adjusted life year (QALY) saved varies depending on the characteristics of the life, LY or QALY under consideration. Despite these findings, budget allocations continue to be made as if all healthy life-years are equivalent. This continued focus on simple health maximisation is partly attributable to gaps in the available evidence. The present study attempts to close some of these gaps. METHODS: Discrete choice experiment to estimate the marginal rate of substitution between cost, effectiveness and various non-health arguments. Odds of selecting profile B over profile A estimated via binary logistic regression. Marginal rates of substitution between attributes (including cost) then derived from estimated regression coefficients. RESULTS: Respondents were more likely to select less costly, more effective interventions with a strong evidence base where the beneficiary did not contribute to their illness. Results also suggest that respondents preferred prevention over cure. Interventions for young children were most preferred, followed by interventions for young adults, then interventions for working age adults and with interventions targeted at the elderly given lowest priority. CONCLUSION: Results confirm that a trade-off exists between cost, effectiveness and non-health arguments when respondents prioritise health programs. That said, it is true that respondents were more likely to select less costly, more effective interventions – confirming that it is an adjustment to, rather than an outright rejection of, simple health maximisation that is required.