PhD defence S.F.W. (Sebastian) Himmler

Dissertation in short:

In publicly funded health care systems decisions need to be made about how to use the available resources and what to include in the basic benefits package. Health economic evaluations are a tool that can inform such decisions. In these evaluations, the costs and benefits of interventions are systematically compared. To date, the included benefits were mostly based on improvements in patient health. However, in areas like elderly care, social care, or palliative care, patient well-being may be a more relevant objective of interventions. Particularly in these areas, the assessment of the overall benefits of interventions would be incomplete if the evaluation would include only health effects, and funding decisions based on such an evaluation could be suboptimal.Consequently, one main objective of this thesis was to conduct research facilitating the use of broader outcome measures in health economic evaluations, which go beyond health and extend the benefit assessment of interventions to well-being. This entailed several studies that tested and applied different methods for weighting the importance of different dimensions of well-being, defined by two validated well-being measures. This weighting is a pre-condition for being able to compute aggregate well-being scores that are used in health economic evaluations. The second main objective was to provide information on the acceptable ratio of costs and benefits of interventions. In the conducted studies, different methodologies that can be used to estimate what ratio would still be acceptable to society were applied. Furthermore, first evidence on value of well-being gains was provided.