Application of discrete choice experiments to value multi-attribute health states for use in economic evaluation

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Economic evaluation is used increasingly by health care decision makers to decide which health care programs provide the best value for money, in terms of improving health and quality of life outcomes for the population. It is used by the Australian government in deciding which medical services and pharmaceuticals should be funded. This requires measurement of quality of life in a way that allows comparison across treatments, and a means of quantifying community preferences for different health states (that is, how we value health outcomes). Health outcomes are often valued using the quality adjusted life year (QALY) which combines length and quality of life in a single measure. To compare across diseases and treatments, quality of life must be measured in the same way. This can be done by using a standard set of questions that cover the different aspects of quality of life (eg pain, mobility, emotional state). In this way, a single survey instrument can be used for any disease or outcome of treatment. We can also use the same instrument to ask members of the public to provide information about their preferences for different health states (that is how they value health outcomes). However, obtaining this information from respondents is complex, and there is debate about which are the best instruments, and the best methods to value health outcomes. In this research, we propose a new approach to valuing health states, which is easier to administer and which allows for more detailed and rigorous analysis of the responses people give, to provide better models of how the different aspects of quality of life are combined in valuing health outcomes. We will compare the new method with the main existing methods. We will compare these methods for two standard quality of life instruments that are widely used in health care research. The research will also provide valuations of health states from the Australian population that can then be used in economic evaluation.