How should we measure health preferences?

Author: Samare Huls, PhD candidate
Arts en patiënt in gesprek

How can we prevent effective medication from not being used? How can we listen to the patient voice, and increase uptake of treatment and patient satisfaction with treatment? And can we make reimbursement decisions more informed by including patient and public preferences?

My name is Samare Huls and I study how well methods that elicit self-reported health preferences measure what they intend to measure, and how well these self-reported preferences match real-world choices. The questions above have been at the centre of my PhD trajectory for almost four years now, and I do quantitative methodological research to answer them. A PhD trajectory is an academic and personal deep dive that supposedly results in a doctoral thesis, a bundle of papers you write to obtain a PhD. I’ve experienced it as a trajectory that requires a combination of persistence, self-deprecation and at times intellectual superiority. I’ve also very much enjoyed the trajectory, and I look forward to continuing to work at the intersect of health, behavioural and experimental economics. In this blog, I would like to familiarise you with my work by giving a sneak peak of the introduction to my doctoral thesis.

Patient preferences

Patient preferences are increasingly used in various contexts such as clinical guidelines, academic research, regulatory decision making and health technology assessment (HTA). Preferences can for example be about how much effectiveness people are willing to give up to experience less side effects, of how far people are prepared to travel to get a certain type of health care. Using this type of preference information in HTA has many benefits. Firstly, aligining health interventions with the preferences of its end-users can increase uptake, adherence and ultimately the efficiency and effectiveness of health interventions. Secondly, there are ethical arguments to listen to the patient voice, and it can increase patient satisfaction. Thirdly, by incorporating patient preferences, the process of HTA is more transparent and therefore the normative value of recommendations based on this assessment increases. More specifically, quantitative patient preference data that is representative for the patient population will make decision making more informed. However, challenges to integrate these patient preferences into HTA in a systematic and scientifically valid way remain.


The overall objective of this thesis is to assess the validity of several quantitative health preference elicitation methods and to contribute to the integration of patient preferences in HTA. To work toward this objective, this dissertation is structured in three parts. The first part outlines the challenges of patient preferences in HTA. The second part describes the internal validity of quantitative health preference research by assessing self-reported adherence and how stated preferences differ depending on risk attitude and elicitation method. The third part addresses how well stated preferences match real-world choices, and the extent to which social desirability plays a role in this.

About the author

Samare Huls is a PhD candidate at Erasmus School of Health Policy & Management. She holds Master’s degree in Behavioural Economics from Erasmus School of Economics, and currently works in the Smarter Choice for Better Health action line ‘Evaluation of Healthcare’. Her research is about internal and external validity of quantitative health preference elicitation methods, and she works at the intersection of health, behavioural and experimental economics. She is motivated by understanding, analysing and communicating the implications of human behaviour in a data-driven way. You can follow Samare’s work here and contact her via email using:

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