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WTP- and QALY-Based Approaches to Valuing Health for Policy: Common Ground and Disputed Territory

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Abstract

This paper discusses links between two approaches to the value of health: the willingness to pay approach of environmental economics and the quality-adjusted life year approach of health economics. The approaches are used in cost-benefit and cost-effectiveness analyses of health interventions. Despite fundamental differences in the decision contexts and conceptual foundations of the two approaches, in current practice they are likely to lead to similar policy decisions. The paper also shows how research on the quality-adjusted life year (QALY) can be used to fill in gaps in the willingness to pay literature. The paper sketches a simple model that shows how to ``QALY-fy the value of a statistical life;'' i.e., how to combine QALY estimates with estimates of the value of a statistical life to estimate willingness to pay for morbidity risks.

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References

  • Bell C. M., Chapman R. H., Stone P. W., Sandberg E. A. and Neuman P. J. (2001). An Off-the-Shelf Help List: A Comprehensive Catalogue of Preference Scores from Published Cost-Utility Analyses. Medical Decision Making 21(4):288–294

    Article  CAS  Google Scholar 

  • Bleichrodt H. and Quiggin J. (1999). Life-Cycle Preferences over Consumption and Health: When is Cost-Effectiveness Analysis Equivalent to Cost-Benefit Analysis?. Journal of Health Economics 18(6): 681–708

    Article  CAS  Google Scholar 

  • Blumstein J. F. (1997) The Oregon Experiment: The Role of Cost-Benefit Analysis in the Allocation of Medicaid Funds. Social Science & Medicine 45(4):545–554

    Article  CAS  Google Scholar 

  • Brent R. J. (2003). Cost Benefit Analysis and Health Care Evaluations. Edward Elgar, Cheltenham, UK

    Google Scholar 

  • Culyer A. J. and Wagstaff A. (1993). QALYs versus HYEs. Journal of Health Economics 11: 311–323

    Article  Google Scholar 

  • Cutler, D. M. and E. Richardson (1997), ‘Measuring the Health Benefits of the U.S. Population'. Brookings Papers on Economic Activity: Microeconomics, 217 – 271

  • Dickie, M. and S. Gerking (2002), ‘Willingness to Pay for Reduced Morbidity.’ Presented at the workshop ‘Economic Valuation of Health for Environmental Policy: Assessing Alternative Approaches,’ March 18–19, 2002, Orlando, Florida

  • Dolan P. (1999). Whose Preferences Count?. Medical Decision Making 19(4): 482–486

    Article  CAS  Google Scholar 

  • Dolan, P. (2000), `The Measurement of Health-Related Quality of Life', in A. J. Culyer and J.␣P.␣Newhouse, eds., Handbook of Health Economics (pp. 1723–1760). Amsterdam: Elsevier

  • Dolan P., Edlin R. (2002) Is It Really Possible to Build a Bridge Between Cost-Benefit Analysis and Cost-Effectiveness Analysis?. Journal of Health Economics 21: 827–843

    Article  Google Scholar 

  • Dolan P. and Jones-Lee M. (1997). The Time Trade-off: A Note on the Effect of Lifetime Reallocation of Consumption and Discounting. Journal of Health Economics 16: 731–739

    Article  CAS  Google Scholar 

  • Dolan P., Jones-Lee M., Loomes G. (1995) Risk-Risk versus Standard Gamble Procedures for Measuring Health States. Applied Economics 27: 1103–1111

    Article  Google Scholar 

  • Dolan P., Gudex C., Kind P., Williams A. (1996). Valuing Health States: A Comparison of Methods. Journal of Health Economics 15(2): 209–231

    Article  CAS  Google Scholar 

  • Drummond M., Cooke J., Walley T. (1997) Economic Evaluation under Managed Competition: Evidence from the UK. Social Science and Medicine 45(4): 583–595

    Article  CAS  Google Scholar 

  • Drummond M. F., O’Brien B., Stoddart G. L., Torrance G. W. (1997) Methods for the Economic Evaluation of Health Care Programmes, 2nd Edition. Oxford University Press, Oxford

    Google Scholar 

  • Edlin, R. (2004), ‘Anti-Social Welfare Functions: A Reply to Hansen et al.' Journal of Health Economics 23(5), 899–905

    Google Scholar 

  • Freeman, A. M. (2002), ‘Valuing Environmental Health Effects – An Economic Perspective.’ Presented at the workshop ‘Economic Valuation of Health for Environmental Policy: Assessing Alternative Approaches,’ March 18–19, 2002, Orlando, Florida

  • Fryback D. G., Dasbach E. J., Klein R. et al. (1993). The Beaver Dam Health Outcomes Study: Initial Catalogue of Health-State Quality Factors. Medical Decision Making 13(2): 89–102

    Article  CAS  Google Scholar 

  • Garber, A. M. (2000), `Advances in CE Analysis', in A. J. Culyer and J. P. Newhouse, eds., Handbook of Health Economics (pp. 181–222). Amsterdam: Elsevier

  • Garber A. M. and Phelps C. E. (1997) Economic Foundations of Cost-Effectiveness Analysis. Journal of Health Economics 16(1): 1–32

    Article  CAS  Google Scholar 

  • Garber A. M., M. C. Weinstein, G. W. Torrance and M. S. Kamlet (1996), `Theoretical Foundations of Cost-Effectiveness Analysis', in M. R. Gold et al. eds., Cost-Effectiveness in Health and Medicine. Oxford: Oxford University Press

  • George B., Harris A., Mitchell A. (2001). Cost-Effectiveness Analysis and the Consistency of Decision Making. Pharmacoeconomics 19(11): 1103–1109

    Article  CAS  Google Scholar 

  • Gold M. R., Siegel J. E., Russell L. B., Weinstein M. C. (1996). Cost-Effectiveness in Health and Medicine. Oxford University Press, Oxford

    Google Scholar 

  • Gryd-Hansen D. (2003). Willingness to Pay for a QALY. Health Economics 12(12): 1049–1060

    Article  Google Scholar 

  • Hammitt J. K. (2002a). QALYs Versus WTP. Risk Analysis 22(5):985–1001

    Article  Google Scholar 

  • Hammitt, J. K. (2002b), ‘How Much is a QALY Worth? Admissible Utility Functions for Health and Wealth.’ Working Paper, Department of Health Policy and Management and Center for Risk Analysis, Harvard University

  • Hansen, B. O., J. L. Hougaard, H. Keiding and L. P. Osterdal (2004), ‘On the Possibility of a Bridge Between CBA and CEA: Comments on a Paper by Dolan and Edlin.’ Journal of Health Economics 23(5), 887–898

    Google Scholar 

  • Hirth R. A., Chernew M. E., Miller E., Fendrick M., Weissert W. G. (2000) Willingness to Pay for a Quality-adjusted Life Year: In Search of a Standard. Medical Decision Making 20(3): 332–342

    Article  CAS  Google Scholar 

  • Hubbell, B. (2002), ‘QALYs in Analyses of Air Pollution Regulations.’ Presented at the workshop ‘Economic Valuation of Health for Environmental Policy: Assessing Alternative Approaches,’ March 18–19, 2002, Orlando, Florida

  • Hurley J. (2000), `An Overview of the Normative Economics of the Health Sector', in A. J. Culyer and J. P. Newhouse, eds., Handbook of Health Economics (pp. 55–118). Amsterdam: Elsevier

  • Johannesson M. (1995) The Relationship Between Cost-Effectiveness Analysis and Cost-Benefit Analysis. Social Science and Medicine 41(4): 483–489

    Article  CAS  Google Scholar 

  • Johannesson M., Meltzer D. (1998) Some Reflections on Cost-effectiveness Analysis. Health Economics 7: 1–7

    Article  CAS  Google Scholar 

  • Johansson P. -O. (1995) Evaluating Health Risks: An Economic Approach. Cambridge University Press, Cambridge

    Google Scholar 

  • Jones-Lee M. W., Hammerton M., Philips P. R. (1985) The Value of Safety: Results of a National Survey. Economic journal 95: 49–72

    Article  Google Scholar 

  • Kaplan R. M., Bush J. W. (1982) Health-Related Quality of Life Measurement for Evaluation Research and Policy Analysis. Health Psychology 1(1): 61–80

    Article  Google Scholar 

  • Kenkel D. S. (2003). Using Estimates of the Value of a Statistical Life in Evaluating Consumer Policy Regulations. Journal of Consumer Policy 26(1): 1–21

    Article  Google Scholar 

  • Klose T. (2003). A Utility-Theoretic Model for QALYs and Willingness to Pay. Health Economics 12(1): 17–31

    Article  Google Scholar 

  • Krupnick A., Alberini A., Cropper M., Simon N., Goeree R. R., Heintzelman M. (2002) Age, Health and Willingness to Pay for Mortality Risk Reductions: A Contingent Valuation Survey of Ontario Residents. Journal of Risk and Uncertainty 24:161– 186

    Article  Google Scholar 

  • Laupacis A., Feeny D., Detscky A. S., Tugwell P. X. (1992). How Attractive Does a New Technology Have to Be to warrant Adoption and Utilization? Tentative Guidelines for Using Clinical and Economic Evaluations. Canadian Medical Association journal 146:473–481

    CAS  Google Scholar 

  • Lyles A., Luce B.R. and Rentz A.M. (1997) Managed Care Pharmacy, Socioeconomic Assessments and Drug Adoption Decisions. Social Science and Medicine 45(4): 511–521

    Article  CAS  Google Scholar 

  • Meltzer D. (1997). Accounting for Future Costs in Medical Cost-Effectiveness Analysis. Journal of Health Economics 16(1):33–64

    Article  CAS  Google Scholar 

  • Meltzer D., Johannesson M. (1999). Inconsistencies in the ‘Societal Perspective’ on Costs of the Panel on Cost-Effectiveness in Health and Medicine. Medical Decision Making 19(4): 371–377

    Article  CAS  Google Scholar 

  • Miller, D., J. Mrozek, C. Calhoun and W. B. Arthur (2002), ‘Societal willingness to Pay Estimates for Morbidity Using Mass-Produced Monetized QALYs.’ Presented at the workshop ‘Economic Valuation of Health for Environmental Policy: Assessing Alternative Approaches,’ March 18–19, 2002, Orlando, Florida

  • Mishan E. J. (1988). Cost-Benefit Analysis, Fourth Edition. Unwin Hyman, London

    Google Scholar 

  • O’Connor R. M., Blomquist G. C. (1997) Measurement of Consumer–Patient Preferences Using a Hybrid Contingent Valuation Method. Journal of Health Economics 16(6): 667–684

    Article  Google Scholar 

  • Office of Management and Budget [OMB](2003), ‘Regulatory Analysis.’ Circular A-4, September 17, 2003

  • Pauly, M. V. (1995), `Valuing Health Care Benefits in Money Terms', in F. Sloan, ed., Valuing Health Care: Costs, Benefits and Effectiveness of Pharmaceuticals and Other Medical Technologies (pp. 99–124). Cambridge: Cambridge University Press

  • Petitti D. B. (1994). Meta-Analysis, Decision Analysis, and Cost-effectiveness Analysis. Oxford University Press, Oxford

    Google Scholar 

  • Phelps C. E., and Mushlin A. I. (1991). On the (Near) Equivalence of Cost-Effectiveness and Cost-Benefit Analyses. International Journal of Technology Assessments in Health Care 7(1): 12–21

    Article  CAS  Google Scholar 

  • Rosen S. (1988). The Value of Changes in Life Expectancy. Journal of Risk and Uncertainty 1: 285–304

    Article  Google Scholar 

  • Rosen, S. (1994), `The Quantity and Quality of Life: A Conceptual Framework', in G. S. Tolley, D. S. Kenkel and R. Fabian, eds., Valuing Health for Policy: An Economic Approach. Chicago: University of Chicago Press

  • Russell L. B. (1999) Improving the Panel’s Recommendations – Comment on Meltzer and Johannesson. Medical Decision Making 19(4): 379–380

    Article  CAS  Google Scholar 

  • Shepard D. S., Zeckhauser R. J. (1982). Life-cycle Consumption and Willingness to Pay for Increased Survival. In: Jones-Lee M. W. (eds) The Value of Life and Safety. North-Holland, New York

    Google Scholar 

  • Sloan F. A., Grabowski H. G. (1997). Introduction and Overview. Social Science and Medicine 45(4): 507–512

    Google Scholar 

  • Smith R. D. (2003) Construction of the Contingent Valuation Market in Health Care: A Critical Assessment. Health Economics 12(8): 609–628

    Article  Google Scholar 

  • Sugden R., Williams A. (1986) The Principles of Practical Cost-Benefit Analysis. Oxford University Press, Oxford

    Google Scholar 

  • Tengs, T. O. and J. D. Graham (1996), ‘The Opportunity Costs of Haphazard Social Investments in Life-saving.’ in R. W. Hahn ed., Risks, Costs, and Lives Saved: Getting Better Results from Regulation (pp. 167–182). New York and Oxford: Oxford University Press and Washington DC: The AEI Press

  • Tolley G. S., Kenkel D. S, Fabian R. (1994). Valuing Health for Policy: An Economic Approach. University of Chicago Press, Chicago

    Google Scholar 

  • U.S. EPA (1997), The Benefits and Costs of the Clean Air Act: 1970–1990. Washington, DC: U.S. Environmental Protection Agency. 410-R–97–002

  • U.S. FDA (1996), ‘Regulations Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco to Protect Children and Adolescents; Final Rule.’ Federal Register August 28, 1996

  • U.S. FDA (1999a), ‘Preliminary Regulatory Impact Analysis and Initial Regulatory Flexibility Analysis of the Proposed Rule to Require Refrigeration of Shell Eggs at Retail and Safe Handling Labels.’ Federal Register July 6, 1999

  • U.S. FDA (1999b), ‘Food labeling: Trans fatty Acids in Nutrition Labeling, Nutrient Content Claims, and Health Claims; Proposed Rule.’ Federal Register November 17, 1999

  • Viscusi W. K. (1992). Fatal Tradeoffs: Public and Private Responsibilities for Risk. Oxford University Press, New York

    Google Scholar 

  • Viscusi W. K., W. A. Magat and J. Huber (1991), Pricing Environmental Health Risks: Survey Assessments of Risk-Risk and Risk-Dollar Tradeoffs for Chronic Bronchitis. Journal of Environmental Economics and Management 21: 32–51

    Article  Google Scholar 

  • Weinstein M. C. (1995) From Cost-Effectiveness Ratios to Resource Allocation: Where to Draw the Line?. In: Sloan F. (eds) Valuing Health Care: Costs, Benefits and Effectiveness of Pharmaceuticals and Other Medical Technologies. Cambridge University Press, Cambridge, pp. 77–98

    Google Scholar 

  • Weinstein M. C. (1999). Theoretically Correct Cost-Efffectiveness Analysis – A Response to Meltzer and Johannesson. Medical Decision Making 19(4): 381–382

    Article  CAS  Google Scholar 

  • Zarkin G. A., Dean N., Mauskopf J. S., Williams R. (1993). Potential Health Benefits of Nutrition Label Changes. American Journal of Public Health 83: 717–724

    Article  CAS  Google Scholar 

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  1. Department of Policy Analysis and Management, Cornell University, Ithaca, NY, 14853, USA

    Don Kenkel

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  1. Don Kenkel
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Correspondence to Don Kenkel.

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Kenkel, D. WTP- and QALY-Based Approaches to Valuing Health for Policy: Common Ground and Disputed Territory. Environ Resource Econ 34, 419–437 (2006). https://doi.org/10.1007/s10640-006-9003-5

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