OBJECTIVES: To assess whether additional life years are valued differently when patients differ in age, life expectancy, or QOL.

METHODS: Trade off questions were developed considering indifference between giving healthy life years to patients with different characteristics: age, prognosis and quality of life. Data concern 46 heart failure patients, 60 healthy age matched controls and 180 students. Each respondent answered 8 trade off questions giving healthy life years to people with different ages, life expectancy and quality of life. Data are analyzed descriptively and with a combination of ordered logistic regression and conditional linear regression. The latter method was chosen after the descriptive analyses showed that many individuals had “extreme” answers in the sense that they either refused to prioritize or did so in a rather extreme way.

RESULTS: Approximately 50% of the answers indicate that people do not wat to prioritize when the differences are small, decreasing to about 30% with bigger differences. On average respondents preferred to give to the young and to those who are worse off. Elderly individuals, more often, prefer not to prioritize. Correcting for the age distribution in the population, an additional QALY in a 20 year old is estimated to be worth 12.8 times that of in an 80 year old. An additional QALY for someone with a life expectancy of 5 years is worth 2.12 times that of someone with a life expectancy of 10 years. An additional QALY for someone with a 0.25 lower utility is estimated to be worth 2.45 times more.

CONCLUSIONS: The opinions about whether a QALY is a QALY is a QALY are diverse; for some they are, but for most people the value depends on the age of the respondent, the prognoses of the patients and the patients' current quality of life.