Towards a Pluralistic Conception of Value in Health: Theoretical Issues and Practical Tools

In this thesis, I present my work on theoretical and methodological issues related to the valuation of health (states) in the context of health technology assessment. It is written in publication format, comprising an introduction and literature review, followed by seven substantive chapters (written in journal article style), organised into two parts, and, finally, a discussion and conclusion. The first part explores the normative foundations for interpersonal utility comparisons and provides a critical examination of current practices, including the ubiquitous use of the arithmetic average to aggregate individual health preferences into social value sets, setting ‘being dead’ to a utility value of zero, and the assignment of negative utility values to health states considered ‘worse than dead’. The second part reports on the development of a practical tool called Online elicitation of Personal Utility Functions (OPUF). It is a new type of online survey for creating value sets using compositional preference elicitation methods, which allow for the construction of value functions for small groups and even on the individual level. The thesis covers the design, pilot testing and application of OPUF to derive value sets from the general population in the UK and from patients with rheumatic diseases in Germany. Both parts of the thesis call into question current standard practices and develop new starting points for a more pluralistic approach to determine the value of health in a society, consisting of individuals with unique preferences, values, and perspectives.