Making Everyone’s Preferences Count: A Prospect Theory Approach to Valuing Health Improvements
NBER Working Papers · 2026 · Karen Mulligan、Drishti Baid、Jason N. Doctor、Darius N. Lakdawalla
中文摘要
卫生技术评估机构和政策制定者一直在探讨一个问题：传统成本效果分析中应当纳入谁的偏好——普通健康人群的偏好，还是患者群体的偏好。这一争论源于健康个体和患者往往对同一健康状态作出不同的价值评价，而且成本效果分析无法考虑适应，因而会低估慢性病或残疾个体的健康相关生活质量（HRQoL）。前景理论（PT）假定个体相对于某个参照点评价结果，因此提供了一个能够容纳适应的分析框架。我们基于具有美国全国代表性的人群样本，在PT框架下估计HRQoL效用，并将其与基于同一人群、在期望效用（EU）框架下得到的效用估计直接进行比较。与货币和健康领域的既有研究一致，我们发现了健康领域中概率加权偏误和损失厌恶的证据。利用PT效用估计，我们说明了如何将PT纳入医疗保健价值评估，并阐述了由此对医疗决策产生的影响。
Abstract
Health technology assessment bodies and policymakers have grappled with the issue of whose preferences – the general healthy population or the patient population – should be incorporated into traditional cost-effectiveness analysis. This debate arises because healthy individuals and patients often value the same health state differently, and cost-effectiveness will undervalue health-related quality of life (HRQoL) for individuals with chronic illness or disability because it cannot account for adaptation. Prospect theory (PT) provides a framework that permits adaptation since it assumes individuals evaluate outcomes relative to a reference point. We estimate utility over HRQoL in a PT framework in a nationally representative U.S. population and compare directly with utility estimates in an EU framework from the same population. Consistent with previous studies in the monetary and health domains, we find evidence of probability weighting bias and loss aversion over health. Using the PT utility estimates, we demonstrate how PT can be incorporated into healthcare value assessment and present the resulting implications for medical decision making.