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Searchers vs surveyors in estimating the monetary value of a QALY: resolving a nasty dilemma for NICE

  • Rachel Baker (a1) (a2), Sue Chilton (a3) (a4), Cam Donaldson (a5) (a6) (a7), Michael Jones-Lee (a8) (a9), Emily Lancsar (a10) (a11) (a12), Helen Mason (a13), Hugh Metcalf (a14) (a15), Mark Pennington (a16) and John Wildman (a17) (a18)...

Recently, for many health economics researchers, empirical estimation of the monetary valuation of a quality-adjusted life year (QALY) has become an important endeavour. Different philosophical and practical approaches to this have emerged. On the one hand, there is a view that, with health-care budgets set centrally, decision-making bodies within the system can iterate, from observation of a series of previous decisions, towards the value of a QALY, thus searching for such a value. Alternatively, and more consistent with the approach taken in other public sectors, individual members of the public are surveyed with the aim of directly eliciting a preference-based – also known as a willingness-to-pay-based (WTP-based) – value of a QALY. While the former is based on supply-side factors and the latter on demand, both in fact suffer from informational deficiencies. Sole reliance on either would necessitate an acceptance or accommodation of chronic inefficiencies in health-care resource allocation. On the basis of this observation, this paper makes the case that in order to approach optimal decision making in health-care provision, a framework incorporating and thus, to a degree, reconciling these two approaches is to be preferred.

Corresponding author
Correspondence to: Cam Donaldson, Yunus Chair in Social Business and Health, NIHR Senior Investigator and Director, Yunus Centre for Social Business and Health, Institute of Applied Health Research, Glasgow Caledonian University, Level 3 Buchanan House, Cowcaddens Road, Glasgow G4 0BA, UK. Email:
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Health Economics, Policy and Law
  • ISSN: 1744-1331
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