How Much Better is Faster? Empirical Tests of QALY Assumptions in Health-Outcome Sequences

F. Reed Johnson, John J. Sheehan, Semra Ozdemir (), Matthew Wallace and Jui-Chen Yang
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F. Reed Johnson: Duke University School of Medicine
John J. Sheehan: Janssen Scientific Affairs
Semra Ozdemir: Duke University School of Medicine
Matthew Wallace: Duke University School of Medicine
Jui-Chen Yang: Duke University School of Medicine

PharmacoEconomics, 2025, vol. 43, issue 1, No 4, 45-52

Abstract: Abstract Objectives This study was designed to test hypotheses regarding the path dependence of health-outcome values in the form of linear additivity of health-state utilities and diminishing marginal utility of health outcomes. Methods We employed a discrete-choice experiment to quantify patient treatment preferences for major depressive disorder. In a series of choice questions, participants evaluated seven symptom-improvement sequences and out-of-pocket costs over 6-week durations. Money-equivalent values were derived from a deductive latent-class mixed-logit analysis. Results The discrete-choice experiment was completed by 751 respondents with self-reported major depressive disorder recruited from an online commercial panel. The class-membership probability was 0.83 for latent-class preferences consistent with supporting relative importance weights for all symptom-improvement sequences in the study design. First, we found strong support for diminishing marginal utility in symptom-improvement sequences. The money-equivalent value of an initial week of normal mood was $147 (95% confidence interval: $128, $166) and a second week of normal mood was $70 ($49, $91). Furthermore, for short treatment durations where conventional discounting was not a factor, equivalent changes in health status were valued more highly for an earlier onset of effect: holding subsequent symptom patterns constant, $338 (211, 454) versus $70 (49, 91) for improvements starting in week 2 versus week 3 and $147 ($128, $166) versus $29 (−$4, $64) for improvements starting in week 3 versus week 4. Conclusions Our findings imply that conventional quality-adjusted life-year calculations in which health values are assumed to be path independent can understate the value of health improvements that appear earlier in a sequence.

Date: 2025
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DOI: 10.1007/s40273-024-01437-0

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