Imagine you have just 10 more years to live, and to make matters worse you will spend your remaining lifetime in a wheelchair. Would you be willing to give up some lifetime to live your remaining years in perfect health? It is questions like these that are often used to quantify the value of health (e.g. lifetime in a wheelchair), which is important information in determining how much you (or other patients in a wheelchair) would gain if you were cured of your health problems. But how does that work?
Let’s say you find living 7 years in perfect health equivalent to living 10 years in a wheelchair. This is interpreted as meaning that you find each year in a wheelchair worth 0.7 healthy life years (obtained by dividing 7 years in perfect health by 10 years in a wheelchair). If you had given up more years, the value of living in a wheelchair would have been higher and vice versa (e.g. if you gave up 5 years, you find 1 year of living in a wheelchair equal to 0.5 healthy life years).
These simple calculations allow answering complicated questions such as: ‘What is worse, losing a hand or losing a foot?’, or ‘How many healthy life years are gained by treating someone for metastatic cancer?’. Answering these questions is crucial in the context of deciding which health care to fund and for whom. However, in contrast to the calculations it enables, determining how many years in perfect health are equivalent to living in a wheelchair is not a simple task. It is, for example, complicated by the fact that many people find next year far more important than the 10th year (i.e. discounting), and will go lengths to avoid giving up anything (i.e. loss aversion).
In my PhD research, I study whether and how such psychological considerations should be incorporated in how we determine the value of health.
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This blog is written by PhD candidate Stefan Lipman of the research group Health Economics of Erasmus School of Health Policy & Management.