Health Economists Want to Maximize QALYs, but Do Patients?

ISSUE: It generally is assumed that patient involvement in clinical decisions increases the likelihood that treatments align with patient preferences, leading to improved health outcomes and patient well-being. While it seems logical that better health outcomes will improve well-being, health is only one component of perceived well-being and could compete with non-health priorities. To avoid undesirable impacts on well-being, patients may be willing to forgo the full benefits of treatment. Consequently, patients could reasonably be expected to use treatments in a way that optimizes overall well-being, but not necessarily overall health. Thus, incorporating patient preferences in patient-centered care potentially conflicts with the goal of cost-effectiveness analysis, which is to maximize gains in health-related quality-adjusted survival within a budget constraint. Why should personal non-health priorities be considered in clinical and reimbursement decision making, and what are the challenges in assessing these non-health priorities?

OVERVIEW: The panel will discuss challenges and opportunities of accounting for non-health determinants of health behaviors in evaluating the full impact of medical technologies. Potential challenges include our limited ability to identify and measure patient preferences for non-health factors that influence health behaviors. Recent developments in the use of patient-preference methods to assess individual-level preferences and frameworks to quantify their role in health-behaviors offer potential avenues to address these challenges. Finally, the panelists will provide an assessment of the potential value of a more holistic evaluation of patient needs and wants in product development, clinical decision-making and market access decisions. Each panelist will take 10 minutes to discuss their perspectives. The moderator will facilitate audience discussion and debate. This discussion will be relevant for a wide range of healthcare stakeholders, including industry, clinical, and reimbursement decision makers.