Eliciting the Relative Value of Life Extension at the End of Life

Rachel Baker of Glasgow Caledonian University and Koonal Shah of OHE discussed societal viewpoints regarding end of life treatments at a recent seminar.

The London Health Economics Group (LHEG) is a forum for health economists across London to present and discuss their research and ideas. It is run by the City Health Economics Centre. OHE hosted the latest LHEG seminar on Thursday 17th November. The speaker was Professor Rachel Baker, Director of the Yunus Centre for Social Business and Health at Glasgow Caledonian University.

Rachel presented the findings of her MRC-funded research project Using Q methodology to investigate societal viewpoints and the relative value of life extension for patients with terminal illness.

A key finding of her work is that there exists a plurality of views regarding the value of life-extending end of life treatments. Some people believe that NHS resources should be allocated on the basis of maximising benefits to the population, with no special cases. Others believe that the desire to preserve life is inherent in human nature, that patient choice is central, and that cost effectiveness should not be the principal basis of coverage decisions. A third group appears to take a more nuanced view in which achieving value for money is important but some treatments, even those associated with small health gains, may yield benefits to patients and families that are of great value at the end of life. Crucially, this third view places more emphasis on quality of life than on extending life.

In a second phase of work, the research team designed an online survey to estimate the prevalence of the three perspectives. In a sample of 4,900 respondents, 37% most agreed with the first viewpoint, 49% with the second and 9% with the third. There are limitations to this approach but, together with the preference elicitation literature on end of life, it would seem to offer good evidence of plurality in public views – raising issues for future research and policy.

Published article: McHugh, N., Baker, R.M., Mason, H., Williamson, L., van Exel, J., Deogaonkar, R., Collins, M. and Donaldson, C., 2015. Extending life for people with a terminal illness: a moral right and an expensive death? Exploring societal perspectives. BMC Medical Ethics, 16(14). [access here free-of-charge]

Access Rachel’s slides below.

Following Rachel’s presentation, OHE’s Koonal Shah provided a critique and discussion. Koonal set out the strengths and limitations of the Q methodology approach, and described how Rachel’s study fits within the existing empirical literature on public preferences regarding the prioritisation of end of life treatments. A recent review found that the existing 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 of studies that do not. This further supports the notion of plurality.

Access Koonal’s slides below.

Related publications include:

• Shah, K.K., Tsuchiya, A. and Wailoo, A.J., 2015. Valuing health at the end of life: A stated preference discrete choice experiment. Social Science & Medicine, 124, pp.48-56. [available to download free-of-charge]
• Shah, K.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. pp. 155-166. [available here]
• Shah, K.K., 2016. Is willingness to pay higher for cancer prevention and treatment? Journal of Cancer Policy. Article in press. [available to download free-of-charge]