OBJECTIVES: Health systems worldwide are moving towards value-based decision-making by implementing care models that coordinate services around patients’ needs. Nevertheless, little is known about the elements of value of health care and their relative importance. In addition, there is an ongoing debate about whether healthcare costs should constitute part of the value metric. This study aimed to define the elements of value of health care and assess their relative importance to the public in England.

METHODS: Elements of value of health care were identified by conducting 26 semi-structured interviews and a systematic literature review. To determine their relative importance (RI) we conducted two discrete choice experiments using a sample of the general public from England: one including the cost attribute, expressed as income tax rise, and the second one excluding it. Respondent preferences were analysed using mixed logit models.

RESULTS: Six elements of value (additional years of life, health-related quality of life, patient experience, size of target population, equity and cost) were identified. 402 members of the public completed the surveys in November 2022. All utility coefficients had the expected signs and were statistically significant (<0.05). RI scores suggested that the public values patient experience (25.2%; 95%CI: 21.6%-28.9%) at least as much as improvements in years of life (25.3%; 95%CI:22.5%-28.6%). While people seem to give a relatively high weight to the size of the target population (22.4%; 95%CI:19.1%-25.6%), equity received the least importance (9.6%; 95%CI:6.4%-12.1%). If cost is included in the value metric, there is an equal drop in the relative importance of quality of life and equity.

CONCLUSIONS: The general public assigns high importance to elements of value that are not captured in conventional value metrics, such as quality adjusted life-year. Although the inclusion of cost did not alter the preference ranking, its inclusion should be considered with caution.