Is There a General Preference for the Worse Off? A Discrete Choice Experiment Using Individually Calibrated Health State Valuations

Objectives We aimed to develop and demonstrate a method for examining public preferences for priority setting in healthcare, using EQ-5D-5L health states valued at an individual level. We examine the Norwegian population’s preferences for prioritizing the “worse off” in terms of health at a cost to health maximization. This intuition is a part of healthcare priority setting frameworks in several countries. Preference studies help explore the legitimacy of such policies, but most studies do not use individual-level health state values, which may distort their conclusions. Methods Task-based face-to-face interviews were conducted in the Norwegian general population. First, respondents valued a set of EQ-5D-5L health states using time trade-off. Second, discrete choice tasks were administered, describing health state improvements that contrasted utility maximization and benefit to the worse off, according to each respondent’s valuation. Analysis used mixed-effects models with choice and respondent properties. Results We conducted 606 interviews, of which 468 respondents were included in the priority setting exercise. Respondents’ choices were influenced by the size of the health improvement, but not by an option being worse in terms of a lower pretreatment health state value. Choice behavior was influenced by respondents’ gender, religion, and age. On average, the choices indicate a preference for prioritizing the better off. Conclusions Our two-stage design using individual health state values is feasible, although there are trade-offs and room for development with such a design. We found no support for a preference for prioritizing the worse off when using individual-level health state valuations.