José Luis Pinto Prades is a full professor in the Department of Economics at the University of Navarra. His research focuses on health economics, with special emphasis on the economic evaluation of healthcare interventions, equity in resource allocation, and health valuation. He has published numerous articles in specialized journals and is co-author of books such as Cost-Benefit Analysis in Health: Valuation Methods and Applications. Additionally, he has collaborated on studies estimating the monetary value of statistical life in Spain and has contributed to the development of methods for prioritizing patients on surgical waiting lists.

Abstract:

OBJECTIVES: To determine whether the discrepancy between individual and social utilities is driven by equity preferences—justifying greater weight for QALYs of more severe patients—or by framing effects, which would call for revising the methods used to elicit individual preferences in health technology assessment.

MATERIALS AND METHODS: We conducted an experiment at the University of Murcia (n=200). Individual preferences were elicited using the Time Trade-Off (TTO) method to estimate utilities for various health states. Social preferences were elicited using two methods (2A and 2B): 2A) choices between groups of patients, and 2B) budget allocation across patient groups. In parallel, two analogous methods (3A and 3B) were used to elicit individual preferences: 3A) choices between treatments for oneself, and 3B) budget allocation between treatments for oneself.

RESULTS: The comparison between utilities derived from TTO and social preferences replicated the common finding in the literature: methods 2A and 2B revealed a tendency to prioritize more severe patients. However, when comparing 2A with 3A and 2B with 3B, we found no significant differences between the treatments individuals prioritized for themselves and those prioritized for patient groups.

CONCLUSION: Our results do not support the introduction of equity weights in health technology assessment. Instead, the apparent discrepancy between individual and social utilities seems to be driven by the insensitivity of the TTO method, rather than by genuine equity preferences.