Presentation (CTI)

OBJECTIVES: Health-related quality-of-life (HRQOL) utility weights aggregate physical and mental health into a single measure of societal value, yet the implicit sensitivities and tradeoffs embedded in these weights are poorly understood. This study characterizes the shape of the societal utility function with respect to physical and mental health, asking how marginal health improvements are valued across the health spectrum. Rather than debating which domains should matter more, we treat the societal value set as given and empirically recover how it converts experienced health into utility.
METHODS: We use nationally representative Medical Expenditure Panel Survey (MEPS) data from 2018-2023. Individuals’ health profiles are measured using the VR-12 instrument and linked to societal utility weights derived from a preference-based discrete choice experiment. Physical and mental health are summarized using the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. We estimate flexible models of societal utility as a function of individual-level PCS and MCS scores, allowing for nonlinearities and interactions. Model performance is assessed using 10-fold cross-validation, and the best-fitting specification is used to characterize the implied societal utility function and its marginal utilities across the spectrum of individual physical and mental health.
RESULTS: Mental health exhibits a U-shaped marginal utility curve. Societal utility is highly sensitive to improvements at very low and very high levels of mental functioning. In contrast, physical health displays diminishing returns throughout the spectrum with marginal utility at its highest at low PCS levels. Unlike physical health, marginal utility for mental health does not converge to zero at high functioning, suggesting that societal valuation extends beyond restoration toward higher levels of psychological well-being.
CONCLUSIONS: Societal HRQOL preferences implicitly prioritize alleviating severe physical limitations while valuing both recovery and flourishing in mental well-being. These asymmetric sensitivities have important implications for how health gains are valued in economic evaluation.