Do you really want to see a 2-year-old suffer? Understanding peoples views on the relative value of health gains by age

ObjectivesStandard economic evaluation methods assume that quality-adjusted life years (QALYs) have equal social value, regardless of recipient. However, evidence suggests that people place greater social value on health gains for children. This study examines the factors driving age-related preferences for health gains. MethodsThink-aloud, semi-structured interviews were conducted with Australian adolescents (n=7), non-parents (n=11), parents with healthy children (n=8) and parents of children with health conditions (n=15). Participants completed Person Trade-Off (PTO) and attitudinal questions about resource allocation for improvements in life extension, mental health, mobility, and pain/discomfort choosing between interventions for adults (ages 40 or 55) and younger people (ages one month to 24). ResultsEleven themes emerged, illustrating participants complex reasoning. They considered differences in the impact of health loss at various ages, with difficulty envisaging mental health impacts for very young children. Emotional responses were strongest around children in pain. Adolescents tended to prioritize younger people, while parents often emphasized adults caregiving role. Most participants prioritized based on age in PTO questions, though some adults objected to prioritizing healthcare based on age. ConclusionChoices were shaped by perceptions of the impact of the health states. These findings provide insight into interpreting quantitative results from PTO tasks.