Evidence is conflicting on whether the marginal utility of health is increasing or diminishing. Research on distributive justice suggests that policy makers should value health improvements more for those with less health. This has led to differential cost-effectiveness thresholds, accepting higher costs for patients with higher disease severity. However, health state classification systems valued from the personal perspective invariably show that health is more important with better health. The aim of the current study is to explain the discrepancy between research on distributive justice and health state classification systems, from the difference in format and in perspective.
Respondents from the Dutch general public (n=710) valued health in different formats (states versus changes) and from different perspectives (personal versus policy). Health was presented using EQ5D profiles, and valued using visual analogue scales. Data were analysed using random effects models, to investigate whether health improvements are more valuable in good health or in poor health.
Few differences were found between the personal and the policy perspective.
Estimates from the state format and the change format were more different.
However, in all analyses, health improvements were considered more valuable in good health than in poor health.
In conclusion, our results consistently show that health improvements are considered more valuable in good health. These results question the robustness of the foundations for using differential cost-effectiveness thresholds.