How is the most severe health state being valued by the general population?

BACKGROUND: It has been reported that valuation of health states that are close to death, such as the most severe health state, can be affected by health state valuation procedure, and their utility values are difficult to predict. We examined how the most severe health states of Short Form-6 dimension (SF-6D) and EuroQoL-5 dimension-3 level (EQ-5D-3L) were valued by the Singapore general population. METHODS: Overall, 249 SF-6D and 42 EQ-5D-3L states were valued by two separate samples from the Singapore general population using the visual analogue scale (VAS) method. Ordinary least-square regression model was employed to explain deficit in the valuation of the most severe state using the health state descriptors. RESULTS: A total of 1021 participants from the SF-6D sample and 1015 participants from the EQ-5D-3L sample were included in the analysis. We observed that 67% of the SF-6D participants and 74% of the EQ-5D-3L participants considered the most severe state worse than dead. The most severe state had mean VAS valuation scores more than 20–25 points lower than the adjacent states that are better by only one level in only one dimension. SF-6D VAS valuation score for the most severe state was 27 points and 12 points lower than expected according to the health state descriptors among the participants who considered the most severe state worse than dead and better than dead, respectively. Similar results were found for the EQ-5D-3L valuation. CONCLUSIONS: The most severe health state was valued lower than expected according to its descriptors.