SHIFTING HEALTH DISTRIBUTIONS UNDER A FIXED SOCIETAL VALUATION: PHYSICAL AND MENTAL HEALTH IN THE U.S.
Author(s)
J. Felipe Montano-Campos, PhD, MS1, Julia Fox, MA2;
1University of Southern California, The Schaffer Institute, Los Angeles, CA, USA, 2University of Washington, The CHOICE Institute, Seattle, WA, USA
1University of Southern California, The Schaffer Institute, Los Angeles, CA, USA, 2University of Washington, The CHOICE Institute, Seattle, WA, USA
OBJECTIVES: Health-related quality-of-life (HRQOL) utilities are often treated as stable preference weights applied uniformly across populations and time. This study examines how shifts in the joint distribution of individuals’ experienced physical and mental health, under a fixed societal utility valuation, change the average marginal value that society assigns to health improvements across years and population characteristics.
METHODS: Using nationally representative Medical Expenditure Panel Survey (MEPS) data from 2018-2023, we link individuals’ VR-12 health profiles to societal utility weights. Physical and mental health are summarized using standardized Physical and Mental Component Summary scores (PCS, MCS). We estimate the same utility specification as a function of PCS and MCS—allowing for nonlinearities and interactions— by year and demographic subgroup, while holding the underlying societal valuation system fixed. Differences across years and groups are assessed by comparing the implied marginal utilities and interaction patterns generated by this common specification.
RESULTS: Although the societal valuation translating health states into utilities remained fixed, the distribution of experienced health shifted over time and across population groups. During the COVID period, mental health declined, became more dispersed, and less correlated with physical health, placing more individuals in regions of the valuation where marginal gains from mental-health improvements were large. Consequently, the population-average marginal value of mental health increased. Across age groups, older adults exhibited the highest marginal value of mental-health improvements, followed by middle-aged and younger adults. Racial and ethnic differences were more heterogeneous, reflecting variation in where groups reside on the joint physical-mental health distribution.
CONCLUSIONS: Time- and group-level differences in the marginal value of health improvements arise from shifts in the distribution of experienced health interacting with a fixed societal valuation, rather than from changes in societal preferences. Ignoring these distributional dynamics may lead to misinterpretation of subgroup or temporal differences in health gains in economic evaluation.
METHODS: Using nationally representative Medical Expenditure Panel Survey (MEPS) data from 2018-2023, we link individuals’ VR-12 health profiles to societal utility weights. Physical and mental health are summarized using standardized Physical and Mental Component Summary scores (PCS, MCS). We estimate the same utility specification as a function of PCS and MCS—allowing for nonlinearities and interactions— by year and demographic subgroup, while holding the underlying societal valuation system fixed. Differences across years and groups are assessed by comparing the implied marginal utilities and interaction patterns generated by this common specification.
RESULTS: Although the societal valuation translating health states into utilities remained fixed, the distribution of experienced health shifted over time and across population groups. During the COVID period, mental health declined, became more dispersed, and less correlated with physical health, placing more individuals in regions of the valuation where marginal gains from mental-health improvements were large. Consequently, the population-average marginal value of mental health increased. Across age groups, older adults exhibited the highest marginal value of mental-health improvements, followed by middle-aged and younger adults. Racial and ethnic differences were more heterogeneous, reflecting variation in where groups reside on the joint physical-mental health distribution.
CONCLUSIONS: Time- and group-level differences in the marginal value of health improvements arise from shifts in the distribution of experienced health interacting with a fixed societal valuation, rather than from changes in societal preferences. Ignoring these distributional dynamics may lead to misinterpretation of subgroup or temporal differences in health gains in economic evaluation.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE97
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas