- This literature review finds an equal split between studies that report evidence consistent with an end of life 'premium' where greater weight is placed on health gains for end of life patients, and studies that do not find evidence for this premium. The evidence is mixed. Factors like the preference elicitation method used and whether indifference options or visual aids were included could impact the likelihood of a study finding an end of life premium. Given framing effects, the researchers recommend using multiple methods to test the robustness of results on valuing health gains for end of life patients.

1. DOES SOCIETY WISH TO PLACE GREATER
WEIGHT ON A UNIT OF HEALTH GAIN FOR
END OF LIFE PATIENTS THAN ON THAT FOR
OTHER TYPES OF PATIENTS?
Koonal Shah (Office of Health Economics, UK; University of Sheffield, UK)
Aki Tsuchiya (University of Sheffield, UK); Allan Wailoo (University of Sheffield, UK)
For further information, contact Koonal Shah – kshah@ohe.org
METHODS
• Primary source of data: electronic search of the Social Sciences Citation
Index (Web of Science), with follow-up of reference lists
• Search strategy: ("end of life" OR severity OR terminal OR “life
expectancy”) AND preferences AND health AND (respondents OR subjects
OR participants OR sampl*)
• To be included, articles had to meet the following sequential criteria:
1. Publication: must be published in English in a peer-reviewed source
2. Empirical data: must review, present or analyse empirical data
3. Priority-setting context: must relate to a health care priority-setting
or resource allocation context
4. Stated preference data: must report preferences that were elicited in
a hypothetical, stated context using a approach involving trade-offs
5. End of life: must address the topic of giving priority to end of life
patients (i.e. patients with short life expectancy) or to treatments for
such patients
6. Original research: must present original research and must not be
solely a review of the literature
References
1. Shah, K., 2016. Does society place special value on end of life treatments? In: Round, J. ed. Care at the end of life: An economic perspective. Cham: Springer.
2. NICE [National Institute for Health and Care Excellence], 2009. Appraising life-extending, end of life treatments. London: NICE.
DISCUSSION AND CONCLUSIONS
• The evidence is mixed, with an equal split between the number of studies that report evidence consistent with an end of life
‘premium’ and the number that do not.
• Likelihood of a study providing evidence consistent with an end of life premium could be linked to the choice of preference
elicitation method and to whether indifference options and visual aids were used.
• Given framing effects, we recommend that researchers use multiple methods/designs to test the robustness of their results.
BACKGROUND
• The debate on whether health gains should
be weighted differently for different patient
groups has focused recently on the relative
value of treatments for patients with short
life expectancy [1].
• It is unclear whether society is prepared to
fund end of life treatments that would not
meet the reimbursement criteria used for
other treatments.
• Study objective: to review the published
literature relevant to the following research
question:
Do members of the general public
wish to place greater weight on a unit
of health gain for end of life patients
than on that for other types of
patients?
SUMMARY
• It is unclear whether or not society places special value on end of life treatments – this literature review finds an equal split
between the number of studies that report evidence consistent with an end of life ‘premium’ and the number that do not.
RESULTS
Freq. (%)
Overall finding: end of life premium
- Evidence consistent with an end of life premium
- Evidence not consistent with an end of life premium
- Mixed or inconclusive evidence
7 (41.2%)
7 (41.2%)
3 (17.6%)
Overall finding: QOL-improving vs. life-extending end of life treatments
- QOL improvement preferred
- Life extension preferred
- Not examined / reported
2 (11.8%)
1 (5.9%)
14 (82.4%)
Variable Evidence
consistent with
EOL premium
Evidence not
consistent with
EOL premium
Country
- UK
- Europe (non-UK)
- Rest of the world
2
3
2
4
2
1
Method a
- DCE
- Other choice exercise
- Willingness-to-pay
- Other
2
2
3
1
2
3
0
2
Mode of administration
- Internet survey
- Other
5
2
4
3
Indifference option offered?
- Yes
- No or not reported
5
2
2
5
Visual aids used?
- Yes
- No or not reported
5
2
2
5
• Variety of methods used: DCE and other
choice exercises, willingness-to-pay, person
trade-off, budget allocation, ranking
• Most studies asked respondents to adopt a
‘social decision maker’ perspective
• Some studies report that respondents are
less concerned about end of life when the
patients in question are relatively old
• 17 studies included in
review
• Majority published after
NICE issued its end of life
policy [2]
• Samples ranged from 23
individuals in a single
small city to >17,000
individuals from nine
different countries
Records identified through
SSCI search (n=598)
Excluded based on title and abstract
(n=547)
1. Publication (n=1)
2. Empirical data (n=1)
3. Priority-setting context (n=545)
4. Stated preference data (n=0)
Titles and abstracts
assessed (n=598)
Full texts assessed
(n=51)
Excluded based on full text assessment
(n=43)
1. Publication (n=0)
2. Empirical data (n=3)
3. Priority-setting context (n=8)
4. Stated preference data (n=1)
5. End of life (n=29)
6. Original research (n=2)
Eligible studies identified
through SSCI search
(n=8)
Studies included
(n=17)
++
Further eligible studies
identified through follow-up
of references (n=5)
Further eligible studies
already known to authors
(n=4)