OBJECTIVES : To allocate scarce healthcare resources efficiently and equitably, equity weights can be incorporated in decision-making frameworks that draw on economic evaluations. This can be accomplished by attaching a weight to health gains or to the monetary threshold against which incremental cost-effectiveness ratios of health technologies are evaluated. Currently applied weights are based on patients’ disease severity (operationalised in terms of absolute shortfall, proportional shortfall, or end-of-life considerations) and do not directly account for age-related preferences in society even though evidence suggests this is an equity-relevant characteristic. The objective of this study was to examine the willingness to pay (WTP) for health-related quality of life (QOL) gains in relation to the disease severity and age of patients, and the outcome of the disease.

METHODS : We obtained WTP estimates by applying contingent-valuation tasks from a socially-inclusive-personal perspective in a representative sample of the public in the Netherlands (n=2,023). We applied random-effects Generalised Least Squares regression models to estimate the effect of patients’ disease severity and age, size of QOL gains, and disease outcome (full recovery/death one year after falling ill), and respondent characteristics on the WTP.

RESULTS : Respondents’ WTP was higher for more severely ill and younger patients and for larger sized QOL gains, but lower for patients who would die one year after falling ill. However, the relations were non-linear and context dependent. Respondents with a lower age, who were male, had a higher household income, and a higher QOL had a higher WTP for QOL gains.

CONCLUSIONS : The results of this study suggest that—if the aim is to align resource-allocation decisions in healthcare with societal preferences—currently applied equity weights do not suffice as they do not sufficiently account for age-related preferences in society.