Willingness to Pay for Health-Related Quality of Life Gains in Relation to Disease Severity and the Age of Patients

Aug 1, 2021, 00:00 AM
Section Order : 1182
First Page : 1182


Decision-making frameworks that draw on economic evaluations increasingly use equity weights to facilitate a more equitable and fair allocation of healthcare resources. These weights can be attached to health gains or reflected in the monetary threshold against which the incremental cost-effectiveness ratios of (new) health technologies are evaluated. Currently applied weights are based on different definitions of disease severity and do not account for age-related preferences in society. However, age has been shown to be an important equity-relevant characteristic. This study examines 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.


We obtained WTP estimates by applying contingent-valuation tasks in a representative sample of the public in The Netherlands (n = 2023). We applied random-effects generalized least squares regression models to estimate the effect of patients’ disease severity and age, size of QOL gains, disease outcome (full recovery/death 1 year after falling ill), and respondent characteristics on the WTP.


Respondents’ WTP was higher for more severely ill and younger patients and for larger-sized QOL gains, but lower for patients who died. However, the relations were nonlinear and context dependent. Respondents with a lower age, who were male, had a higher household income, and a higher QOL stated a higher WTP for QOL gains.


Our results suggest that—if the aim is to align resource-allocation decisions in healthcare with societal preferences—currently applied equity weights do not suffice.

HEOR Topics :
  • Clinical Outcomes
  • Clinical Outcomes Assessment
  • Methodological & Statistical Research
  • Patient-Centered Research
  • Patient-reported Outcomes & Quality of Life Outcomes
  • Survey Methods
Tags :
  • age
  • end of life
  • health-related quality of life
  • severity of illness
  • willingness to pay
Regions :
  • Western Europe