Finding a nicer way to value health: From hypothetical preferences to real experiences

Following recent controversies over the availability of expensive drugs on the NHS, NICE’s work in allocating the NHS’s spending on medical treatments is coming under increasing scrutiny. In this essay, Professor Paul Dolan challenges the methodology used by NICE to determine the cost-effectiveness of different treatments.

It currently values different states of health using a ‘preference-based’ method. It asks respondents to imagine themselves in different hypothetical states of health, such as with mobility problems. They then have to decide how many years of life they would give up, or what risk of death they would be willing to accept in order to be in full health rather than in the hypothetical state of ill health.

Dolan argues that preferences such as these are not a good guide to future experiences and as such, NICE’s current practice can lead to a misallocation of resources. For instance, mental health services are likely to be under-valued and under-funded relative to treatments that improve physical functioning.

A more suitable way to value health, according to Dolan, is to ask people in different states of health how they think and feel about their lives. He proposes to ration healthcare according to real experiences rather than according to hypothetical preferences.

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