Werner Brouwer

Objectives: The optimal point in time to measure willingness-to-pay (WTP) remains unclear. We investigated the role of health information shocks (HIS) in individuals’ WTP, analyzing the extent to which news of SARS-CoV-2 infections among people they know/themselves altered WTP for booster vaccinations. Methods: We elicited WTP in eight European countries using the European Covid Survey. First, we presented participants with a hypothetical setting recommending a booster vaccination that had to be paid out-of-pocket. To measure WTP, we elicited a lower and upper WTP limit, and a WTP value contingent on both of these. To measure HIS, we asked about the duration since participants received news of COVID-19 cases among people they know (including themselves), as well as the degree of personal connection to these cases and their severity. We used a two-part model to estimate the association between HIS and individuals’ WTP. Results: Among the 5809 observations, 76.8% stated a WTP for a booster vaccination greater than €0. At least one HIS was reported by 61.9% of participants. The occurrence of a HIS was associated with an increase in WTP of €14.54 (logistic: P <.0001, gamma: P =.1493) compared to no HIS. The WTP was higher when the HIS occurred in the four weeks before the survey. Controlling for socio-demographic and COVID-19 covariates decreased significance and effect sizes. Conclusion: Our findings suggest that a recent HIS is associated with a higher probability of having a positive WTP. Timing, in relation to some relevant event, therefore may matter when measuring WTP for health interventions. If so, finding the optimal point in time to measure WTP is difficult and may depend on the policy question under consideration.

Adopting a societal perspective in cost-effectiveness analysis (CEA) requires including all societal costs and benefits even if they fall outside of the realm of health and healthcare. While some benefits are not explicitly included, they might be implicitly included when people value quality-adjusted life-years (QALYs) in monetary terms. An example is utility of consumption (UoC) which has played a crucial role in discussions regarding the welfare economic underpinnings of CEA. This study investigates whether people consider elements beyond health when valuing QALYs monetarily and the influence of inclusion on this value. A Willingness to Pay (WTP) experiment was administered among the general public in which people were asked to assign monetary values to QALYs. Our results show that (stated) UoC increases with quality of life but that instructing people to consider UoC does not impact their monetary valuation of the QALY. Furthermore, many respondents consider elements beyond health when valuing QALYs but the impact on the monetary value of a QALY is limited. These findings suggest that these elements are currently not (adequately) captured in CEA. Findings also illustrate that it is difficult to isolate health from non-health benefits and to consistently capture these in CEA. With that, reconciling CEA with welfare economics remains challenging.

It’s increasingly recognized that the evaluative space of economic evaluations in health and social care needs to be broadened and instruments measuring well-being are required. A generic measure of well-being comprehensively capturing all relevant domains of well-being in the adult population is not available. The aim is to describe the development of such an instrument, the 10-item Well-being instrument (WiX), and to report the findings from a content validation study. A draft version of the instrument was based on available instruments pursuing the same aim, a comprehensive theoretical framework of the domains of well-being, and recent empirical evidence from the general population about the constituents of well-being. Content validation was conducted following COSMIN methodology and investigated relevance, comprehensiveness, and comprehensibility. In the qualitative content validation, semi-structured interviews were conducted with experts and members of the general population. During quantitative content validation, a representative sample (n = 501) from the general population completed an online survey. The qualitative validation showed the relevance and comprehensiveness of the WiX were adequate, but several changes were made to consecutive draft versions of the items and their descriptions and response levels to improve comprehensibility. The quantitative validation confirmed these findings and resulted in some additional, minor changes. A new instrument aiming to capture overall (or general) quality-of-life in terms of subjective well-being by measuring how satisfied people are on ten important domains of life in the adult general population was developed. The content validation results are encouraging, but further validation and valuation steps are necessary before the WiX can be used in (economic) evaluation studies of interventions with impacts broader than health.

Background Omission of family and caregiver health spillovers from the economic evaluation of healthcare interventions remains common practice. When reported, a high degree of methodological inconsistency in incorporating spillovers has been observed. Aim To promote emerging good practice, this paper from the Spillovers in Health Economic Evaluation and Research (SHEER) task force aims to provide guidance on the incorporation of family and caregiver health spillovers in cost-effectiveness and cost-utility analysis. SHEER also seeks to inform the basis for a spillover research agenda and future practice. Methods A modified nominal group technique was used to reach consensus on a set of recommendations, representative of the views of participating subject-matter experts. Through the structured discussions of the group, as well as on the basis of evidence identified during a review process, recommendations were proposed and voted upon, with voting being held over two rounds. Results This report describes 11 consensus recommendations for emerging good practice. SHEER advocates for the incorporation of health spillovers into analyses conducted from a healthcare/health payer perspective, and more generally inclusive perspectives such as a societal perspective. Where possible, spillovers related to displaced/foregone activities should be considered, as should the distributional consequences of inclusion. Time horizons ought to be sufficient to capture all relevant impacts. Currently, the collection of primary spillover data is preferred and clear justification should be provided when using secondary data. Transparency and consistency when reporting on the incorporation of health spillovers are crucial. In addition, given that the evidence base relating to health spillovers remains limited and requires much development, 12 avenues for future research are proposed. Conclusions Consideration of health spillovers in economic evaluations has been called for by researchers and policymakers alike. Accordingly, it is hoped that the consensus recommendations of SHEER will motivate more widespread incorporation of health spillovers into analyses. The developing nature of spillover research necessitates that this guidance be viewed as an initial roadmap, rather than a strict checklist. Moreover, there is a need for balance between consistency in approach, where valuable in a decision making context, and variation in application, to reflect differing decision maker perspectives and to support innovation.

Well-being has gained interest as object of study in the social sciences and as an outcome measure for policy evaluation. However, little agreement exists with respect to the substantive meaning of well-being, the dimensions of well-being that should be considered in a multi-dimensional approach, and the variety of well-being conceptions people have for their own lives. This study explored conceptions of “a good life for you” among 1,477 adult people from the Netherlands by means of Q-methodology, based on a theoretical framework synthesizing the main theories of well-being. We find five distinct views on what people consider to be a good life for themselves: “Health and feeling well”, “Hearth and home”, “Freedom and autonomy”, “Social relations and purpose” and “Individualism and independence”. While there is strong agreement with respect to the importance of feeling both physically and mentally well, the views diverge considerably regarding aspects such as social relations, autonomy, spirituality, and material welfare. Associations between viewpoints and respondent characteristics had face validity. The findings of this study have significant implications for the development of measures of well-being and policies aimed to improve population well-being. Further research is required into the prevalence of these views on well-being in the population, their relation to respondent characteristics and into differences in views over time and between countries with different socio-economic, political and cultural environments.

Background Compensation mechanisms and multiplier effects may affect productivity losses due to illness, disability, or premature death of individuals. Hence, they are important in estimating productivity losses and productivity costs in the context of economic evaluations of health interventions. This paper presents a systematic literature review of papers focusing on compensation mechanisms and multiplier effects, as well as whether and how they are included in health economic evaluations. Methods The systematic literature search was performed covering EconLit and PubMed. A data-extraction form was developed focusing on compensation mechanisms and multiplier effects. Results A total of 26 studies were included. Of these, 15 were empirical studies, three studies were methodological studies, two studies combined methodological research with empirical research, four were critical reviews, one study was a critical review combined with methodological research, and one study was a cost–benefit analysis. No uniform definition of compensation mechanisms and multiplier effects was identified. The terminology used to describe compensation mechanisms and multiplier effects varied as well. While the included studies suggest that both multipliers as well as compensation mechanisms substantially impact productivity cost estimates, the available evidence is scarce. Moreover, the generalizability as well as validity of assumptions underlying the calculations are unclear. Available measurement methods for compensation mechanisms and multiplier effects differ in approaches and are hardly validated. Conclusion While our review suggests that compensation mechanisms and multiplier effects may have a significant impact on productivity losses and costs, much remains unclear about their features, valid measurement, and correct valuation. This hampers their current inclusion in economic evaluation, and therefore, more research into both phenomena remains warranted.