Increasing the role of patient values in economic evaluation

Economic evaluation of health care in recent years has been dominated by one approach, which is to compare interventions on the basis of their incremental cost per quality adjusted life year (NICE) to an accepted ‘threshold’. In England this approach has been used by the National Institute of Health and Care Excellence (NICE) to evaluate new drugs. A key component is to use general population values of the health states to calculate QALYs, through the use of cold calling or online methods of preference elicitation. These methods allow very little time for reflection and deliberation, and do not assist the general public in making informed judgements on something that will be used to inform important decisions on the way scarce resources are used in the NHS.

These methods have been criticised by influential figures such as Nobel laureate Daniel Kahneman on the grounds that we are very poor at predicting the impact of a health state on our lives (Dolan and Kahneman, 2008). It has been argued that it would be better to use values based on the actual experience of living in the health state – sometimes called experience utility. There has been empirical work in recent years starting to collect this experience data from patients and others in the relevant health states using a variety of techniques. This work has been criticised for being poorly specified and designed, and there are concerns that such values also reflect a degree of low expectations and denial in those experiencing some of the poorest states (Brazier et al, 2005; Brazier et al, 2016).

This PhD would aim to develop a practical way of obtaining and then using experience-based values to better inform general population valuation of health (e.g. EQ-5D, SF-6D). The student would be part of a large research programme in the measurement and valuation of health and well-being based in ScHARR. The thesis would involve three stages. A review of the evidence on the difference between general population valuations of health states compared to those experiencing them, and the reasons for the differences. The aim would be to use this to develop hypothesise for testing in the next component of the study and to inform the development of the method in component three. Secondly, conduct further empirical work into this relationship using existing data sets (such as US, HSE, MIC) and some original survey work. Thirdly, develop methods for enabling these values to be used to inform public deliberation and at least one application of the methods to examine their feasibility. It would be hoped that this would contribute to the development of a post-doctoral fellowship to develop the methods further.

How to apply

Please apply through our online postgraduate application system including the Scholarship Application section where you need to tick the ’University Scholarships’ box. The form will ask you to summarise your research proposal in less than 800 words. If you are unsure about what to put in this section, please contact your prospective supervisor. Please name your supervisor and select their department (ScHARR) through the online form.

Deadline: 5pm 1st February 2017