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Recognizing diversity in public preferences: The use of preference sub‐groups in cost‐effectiveness analysis

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  • Mark Sculpher
  • Amiram Gafni

Abstract

Public preferences are typically incorporated into cost‐effectiveness analyses (CEA) on the basis of the average health state utilities of a sample of individuals drawn from the general public. The cost‐effectiveness of a programme is then assessed on an ‘all‐or‐nothing’ basis: the programme is declared either cost‐effective or not for all patients in clinically homogenous sub‐groups. However, this approach fails to recognize variability between individuals in their preferences. In this paper, we consider how diversity in the preferences of individuals can be handled within CEA when the public's preferences are considered appropriate for defining benefit, with the objective of increasing the efficiency of health care delivery. The concept of preference sub‐group analysis is described and some of its implications are assessed. These include the methods that could be used to identify sub‐groups from amongst public raters, the appropriate approach to eliciting preferences and the possible implications of preference sub‐group analysis for clinical decision making. Copyright © 2001 John Wiley & Sons, Ltd.

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  • Mark Sculpher & Amiram Gafni, 2001. "Recognizing diversity in public preferences: The use of preference sub‐groups in cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 317-324, June.
    • Handle: RePEc:wly:hlthec:v:10:y:2001:i:4:p:317-324
    DOI: 10.1002/hec.592
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    Cited by:

    1. Gregory S. Zaric, 2008. "Optimal drug pricing, limited use conditions and stratified net benefits for Markov models of disease progression," Health Economics, John Wiley & Sons, Ltd., vol. 17(11), pages 1277-1294, November.
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    3. Jennifer Roberts & Paul Dolan, 2004. "To what extent do people prefer health states with higher values? A note on evidence from the EQ‐5D valuation set," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 733-737, July.
    4. Siciliani, Luigi & Straume, Odd Rune, 2019. "Competition and equity in health care markets," Journal of Health Economics, Elsevier, vol. 64(C), pages 1-14.
    5. Angela Robinson & David Parkin, 2002. "Recognising diversity in public preferences: the use of preference sub‐groups in cost‐effectiveness analysis. A response to Sculpher and Gafni," Health Economics, John Wiley & Sons, Ltd., vol. 11(7), pages 649-651, October.
    6. Gemma E. Shields & Paul Clarkson & Ash Bullement & Warren Stevens & Mark Wilberforce & Tracey Farragher & Arpana Verma & Linda M. Davies, 2024. "Advances in Addressing Patient Heterogeneity in Economic Evaluation: A Review of the Methods Literature," PharmacoEconomics, Springer, vol. 42(7), pages 737-749, July.
    7. Ian M. McCarthy, 2015. "Putting the Patient in Patient Reported Outcomes: A Robust Methodology for Health Outcomes Assessment," Health Economics, John Wiley & Sons, Ltd., vol. 24(12), pages 1588-1603, December.
    8. Stephen Birch & Amiram Gafni, 2002. "On being NICE in the UK: guidelines for technology appraisal for the NHS in England and Wales," Health Economics, John Wiley & Sons, Ltd., vol. 11(3), pages 185-191, April.
    9. Gemma E. Shields & Mark Wilberforce & Paul Clarkson & Tracey Farragher & Arpana Verma & Linda M. Davies, 2022. "Factors Limiting Subgroup Analysis in Cost-Effectiveness Analysis and a Call for Transparency," PharmacoEconomics, Springer, vol. 40(2), pages 149-156, February.
    10. Nancy J. Devlin & Koonal K. Shah & Yan Feng & Brendan Mulhern & Ben van Hout, 2018. "Valuing health‐related quality of life: An EQ‐5D‐5L value set for England," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 7-22, January.
    11. Moreno, E. & Girón, F.J. & Martínez, M.L. & Vázquez-Polo, F.J. & Negrín, M.A., 2013. "Optimal treatments in cost-effectiveness analysis in the presence of covariates: Improving patient subgroup definition," European Journal of Operational Research, Elsevier, vol. 226(1), pages 173-182.
    12. Werner B.F. Brouwer & Frans F.H. Rutten, 2003. "The missing link: on the line between C and E," Health Economics, John Wiley & Sons, Ltd., vol. 12(8), pages 629-636, August.
    13. Clazien Bouwmans & Annemarie Kolk & Mark Oppe & Saskia Schawo & Elly Stolk & Michel Agthoven & Jan Buitelaar & LeonaHakkaart Roijen, 2014. "Validity and responsiveness of the EQ-5D and the KIDSCREEN-10 in children with ADHD," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(9), pages 967-977, December.
    14. Gregory S. Zaric, 2008. "Optimal drug pricing, limited use conditions and stratified net benefits for Markov models of disease progression," Health Economics, John Wiley & Sons, Ltd., vol. 17(11), pages 1277-1294.

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