Testing a new method for estimating the monetary value of a QALY.

Objectives
The objective of this thesis is to develop and test a new method, based on Time Trade-Off
(ITO), for the estimation of the monetary value of a QALY (MVQ) informed by public
preferences.
Methods
Two new questions are developed to estimate an MVQ which ask respondents to trade off
length of life to either increase their income, or avoid a decrease in their income. These
questions are initially tested through a Dutch online survey with 321 members of the Dutch
general public. The questions are further tested through a small scale pilot study, followed
by a UK based interview study with 100 members of the general public. In addition, two
further questions are also developed and tested in the UK study, which are more closely
aligned with the concepts of Willingness to Pay and Willingness to Accept.
Results
In the Dutch online survey there were a large number of respondents who were not
prepared to trade any time to increase their income (or avoid a decrease). Furthermore,
some respondents traded too much time, which led to negative MVQ estimates. The
prevalence of these responses reduced in the UK based interview study but they were still
problematic. Despite this, the questions did appear to be feasible for respondents to
complete and were sensitive to scale, particularly in the UK study.
Conclusion
The evidence tentatively suggests that at least some of the respondents stating an infinite
preference for length of life over income, were giving a true statement of preference. The
questions could potentially be improved by either decreasing the total value of what is
being given up, or by increasing the total value of what is being gained. This could
potentially be achieved by extending the time horizon in the exercise.