Do Misconceptions About Health-Related Quality of Life Affect General Population Valuations of Health States?

Published:October 30, 2022DOI:


      • Previous research conjectures that misconceptions about ill-health’s consequences of quality of life (QOL) may affect evaluations of health states by the general population.
      • We found that people who were given information on the QOL consequences of experiencing each health state that was evaluated reported a higher relative preference for avoiding living with moderate anxiety/depression.
      • Our results show that providing information about QOL consequences of health states affects preferences; therefore policymakers may wish to consider supplementing existing quality-adjusted life-year outcome measures with quality-adjusted life-years computed using general population preferences that are informed about the QOL consequences of health states.


      Healthcare resource allocation decisions are often informed by the expected gains in patients’ quality-adjusted life-years. Misconceptions about ill-health’s consequences for quality of life (QOL) may however affect evaluations of health states by the general population and hence affect resource allocation decisions informed by quality-adjusted life-years. We examine whether people selectively misestimate the QOL consequences of moderate anxiety or depression compared with other dimensions of health, and we test whether informing people of actual changes in QOL associated with health states changes appraisals of their relative undesirability.


      UK general population participants (N = 1259; in 2017) expressed preferences over moderate problems: anxiety or depression, self-care, and pain or discomfort. A randomized control trial design was used whereby a control group was given a functional description of each health state, and 2 intervention groups were additionally given information on the actual differences in either life satisfaction (LS) or day affect (DA) associated with experiencing each health state.


      The LS (DA) group reported a higher preference for avoiding living with moderate anxiety or depression, being 13.4% (13.9%) more likely to choose it as most undesirable.


      Informing people of the change in LS or DA associated with health states before they appraise them is a feasible way to obtain informed preferences.


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        • Briggs A.
        • Gray A.
        Economics notes - using cost effectiveness information.
        Br Med J. 2000; 320 (–246): 246
        • Birch S.
        • Gafni A.
        The ‘NICE’ approach to technology assessment: an economics perspective.
        Health Care Manag Sci. 2004; 7: 35-41
      1. Guide to the methods of technology appraisal 2013. National Institute for Health and Care Excellence.
        • Weinstein M.C.
        • Torrance G.
        • McGuire A.
        QALYs: the basics.
        Value Health. 2009; 12: S5-S9
        • Gold M.R.
        • Siegel J.E.
        • Russell L.B.
        • Weinstein M.C.
        Cost-Effectiveness in Health and Medicine.
        Oxford University Press, New York, NY1996
        • Neumann P.J.
        • Greenberg D.
        Is the United States ready for QALYs?.
        Health Aff. 2009; 28: 1366-1371
        • Zhang K.
        • Garau M.
        International cost-effectiveness thresholds and modifiers for HTA decision making. Office of Health Economics.
        • Karimi M.
        • Brazier J.
        • Paisley S.
        Are preferences over health states informed?.
        Health Qual Life Outcomes. 2017; 15: 105
        • Dolan P.
        • Metcalfe R.
        Valuing health: a brief report on subjective well-being versus preferences.
        Med Decis Making. 2012; 32: 578-582
        • Mukuria C.
        • Brazier J.
        Valuing the EQ-5D and the SF-6D health states using subjective well-being: a secondary analysis of patient data.
        Soc Sci Med. 2013; 77: 97-105
        • Drummond M.
        • Brixner D.
        • Gold M.
        • et al.
        Toward a consensus on the QALY.
        Value Health. 2009; 12: S31-S35
        • Brazier J.
        • Akehurst R.
        • Brennan A.
        • et al.
        Should patients have a greater role in valuing health states?.
        Appl Health Econ Health Policy. 2005; 4: 201-208
        • McTaggart-Cowan H.M.
        • Tsuchiya A.
        • O’Cathain A.
        • Brazier J.
        Understanding the effect of disease adaptation information on general population values for hypothetical health states.
        Soc Sci Med. 2011; 72: 1904-1912
        • Murphy R.P.
        • Boyce C.J.
        • Dolan P.
        • Wood A.M.
        Valuing the Q in QALYs: does providing patients’ ratings affect population values?.
        Health Psychol. 2020; 39: 37-45
        • Dolan P.
        • Kavetsos G.
        • Tsuchiya A.
        Sick but satisfied: the impact of life and health satisfaction on choice between health scenarios.
        J Health Econ. 2013; 32: 708-714
        • Wood A.M.
        • Davidson A.T.
        Why the field of moral philosophy must guide any discussion on well-being.
        World Psychiatry. 2020; 19: 53-55
        • Shin D.
        • Johnson D.
        Avowed happiness as an overall assessment of quality of life.
        Socindic Res. 1978; 5: 475-492
        • Mulhern B.
        • Longworth L.
        • Brazier J.
        • et al.
        Binary choice health state valuation and mode of administration: head-to-head comparison of online and CAPI.
        Value Health. 2013; 16: 104-113
      2. EQ-5D-3L user guide. EuroQol Group.
        Date accessed: January 20, 2022
        • Kind P.
        • Dolan P.
        • Gudex C.
        • Williams A.
        Variations in population health status: results from a United Kingdom national questionnaire survey.
        Br Med J. 1998; 316: 736-741
        • Shaw J.W.
        • Johnson J.A.
        • Coons S.J.
        US valuation of the EQ-5D health states: development and testing of the D1 valuation model.
        Med Care. 2005; 43: 203-220
        • Stolk E.
        • Ludwig K.
        • Rand K.
        • van Hout B.
        • Ramos-Goni J.M.
        Overview, update, and lessons learned from the international EQ-5D-5L valuation work: version 2 of the EQ-5D-5L valuation protocol.
        Value Health. 2019; 22: 23-30
        • Jiang R.
        • Shaw J.
        • Muhlbacher A.
        • et al.
        Comparison of online and face-to-face valuation of the EQ-5D-5L using composite time trade-off.
        Qual Life Res. 2021; 30: 1433-1444
        • Norman R.
        • King M.
        • Clarke D.
        • Viney R.
        • Cronin P.
        • Street D.
        Does mode of administration matter? Comparison of online and face-to-face administration of a time trade-off task.
        Qual Life Res. 2010; 19: 499-508
        • Versteegh M.
        • Brouwer W.
        Patient and general public preferences for health states: a call to reconsider current guidelines.
        Soc Sci Med. 2016; 165: 66-74
        • Hudson N.W.
        • Lucas R.E.
        • Donnellan M.B.
        A direct comparison of the temporal stability and criterion validities of experiential and retrospective global measures of subjective well-being.
        J Res Pers. 2022; 98104230
        • Williams R.
        Generalized ordered logit/partial proportional odds models for ordinal dependent variables.
        STATA J. 2006; 6: 58-82
        • Schkade D.
        • Kahneman D.
        Does living in California make people happy? A focusing illusion in judgments of life satisfaction.
        Psychol Sci. 1998; 9: 340-346
        • Harsanyi J.
        Utilities, preferences, and substantive goods.
        Soc Choice Welf. 1997; 14: 129-145
        • Shiell A.
        • Hawe P.
        • Fletcher M.
        Reliability of health utility measures and a test of values clarification.
        Soc Sci Med. 2003; 56: 1531-1541
        • Stein K.
        • Ratcliffe J.
        • Round A.
        • Milne R.
        • Brazier J.E.
        Impact of discussion on preferences elicited in a group setting.
        Health Qual Life Outcomes. 2006; 4 (–22): 22
        • Ryff C.
        Happiness is everything, or is it - explorations on the meaning of psychological well-being.
        J Pers Soc Psychol. 1989; 57: 1069-1081
        • Keyes C.
        • Shmotkin D.
        • Ryff C.
        Optimizing well-being: the empirical encounter of two traditions.
        J Pers Soc Psychol. 2002; 82: 1007-1022
        • Linley P.A.
        • Maltby J.
        • Wood A.M.
        • Osborne G.
        • Hurling R.
        Measuring happiness: the higher order factor structure of subjective and psychological well-being measures.
        Pers Individ Dif. 2009; 47: 878-884
        • Menzel P.
        • Dolan P.
        • Richardson J.
        • Olsen J.A.
        The role of adaptation to disability and disease in health state valuation: a preliminary normative analysis.
        Soc Sci Med. 2002; 55: 2149-2158
        • Baker R.
        • Robinson A.
        Responses to standard gambles: are preferences ‘well constructed’?.
        Health Econ. 2004; 13: 37-48
        • van der Pol M.
        • Shiell A.
        Extrinsic goals and time tradeoff.
        Med Decis Making. 2007; 27: 406-413
        • Myers J.
        • McCabe S.
        • Gohmann S.
        Quality-of-life assessment when there is a loss of income.
        Med Decis Making. 2007; 27: 27-33
        • Brouwer W.B.
        • Grootenboer S.
        • Sendi P.
        The incorporation of income and leisure in health state valuations when the measure is silent: an empirical inquiry into the sound of silence.
        Med Decis Making. 2009; 29: 503-512
        • Krol M.
        • Brouwer W.
        • Sendi P.
        Productivity costs in health-state valuations: does explicit instruction matter?.
        Pharmacoeconomics. 2006; 24: 401-414
        • Karimi M.
        • Brazier J.
        • Paisley S.
        How do individuals value health states? A qualitative investigation.
        Soc Sci Med. 2017; 172: 80-88
        • van Osch S.
        • Stiggelbout A.
        Understanding VAS valuations: qualitative data on the cognitive process.
        Qual Life Res. 2005; 14: 2171-2175
        • Stiggelbout A.M.
        • de Vogel-Voogt E.
        Health state utilities: a framework for studying the gap between the imagined and the real.
        Value Health. 2008; 11: 76-87
        • Ubel P.A.
        • Loewenstein G.
        • Jepson C.
        Whose quality of life? A commentary exploring discrepancies between health state evaluations of patients and the general public.
        Qual Life Res. 2003; 12: 599-607