The influence of ill-health experience on the valuation of health

Social valuations for health states are potentially useful both in clinical decision-making and in health-resource allocation, but there is some evidence that the experience of illness may affect such valuations. This article compares valuations of hypothetical health states obtained from a sample of chronically ill patients, with valuations obtained from a sample of relatively healthy individuals. The instrument used to obtain these values was the EuroQOL 5D questionnaire (EQ-5D). We found that the EQ-5D values of chronically ill patients differed significantly from the values obtained from healthier individuals, particularly in the case of the more severe health states. Healthy individuals assigned negative values to some hypothetical health states, indicating that they consider them to be worse than death, whereas chronically ill patients assigned positive values to all health states. These results raise difficult questions about whose values should count when health-status measures are incorporated in clinical and economic evaluation, and in particular when deciding upon the allocation of scarce resources.