Comparing WTP values of different types of QALY gain elicited from the general public

Mark Pennington, Rachel Baker, Werner Brouwer, Helen Mason, Dorte Gyrd Hansen, Angela Robinson, Cam Donaldson

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62 Citations (Scopus)


The appropriate thresholds for decisions on the cost-effectiveness of medical interventions remain controversial, especially in ‘end-of-life’ situations. Evidence of the values placed on different types of health gain by the general public is limited.

Across nine European countries, 17 657 people were presented with different hypothetical health scenarios each involving a gain of one quality adjusted life year (QALY) and asked about their willingness to pay (WTP) for that gain. The questions included quality of life (QoL) enhancing and life extending health gains, and a scenario where respondents faced imminent, premature death.

The mean WTP values for a one-QALY gain composed of QoL improvements were modest (PPP$11 000). When comparing QALY gains obtained in the near future, the valuation of life extension exceeded the valuation of QoL enhancing gains (mean WTP PPP$19 000 for a scenario in which a coma is avoided). The mean WTP values were higher still when respondents faced imminent, premature death (PPP$29 000).

Evidence from the largest survey on the value of health gains by the general public indicated a higher value for life extending gains compared with QoL enhancing gains. A further modest premium may be indicated for life extension when facing imminent, premature death.
Original languageEnglish
Pages (from-to)280–293
Number of pages14
JournalHealth Economics
Issue number3
Early online date11 Dec 2013
Publication statusPublished - Mar 2015


  • contingent valuation
  • willingness-to-pay
  • EuroVaQ

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