Rachel Baker

Professor of Health Economics

Yunus Centre for Social Business & Health

Perspectives, priorities and plurality

What matters to people: priorities for individuals,

communities and populations

Priorities 2016

Some background

Using Q methodology to investigate societal

viewpoints and the relative value of life extension for

patients with terminal illness

MRC Methodology Panel funding 2011-2014 Rachel Baker, Helen Mason, Neil McHugh, Cam Donaldson, Laura Williamson, Jon Godwin, (GCU) Marissa Collins, Rohan Deogaonkar Job van Exel (Erasmus, Rotterdam) Cathy Hutchinson (Beatson Cancer Centre)

Perspectives, Priorities and Plurality

Societal values and priority setting

• And use of terms: values/viewpoints, preferences/perspectives

End of life – a case in point

• End of life policy and claims about societal values (2009)

• Research evidence (2010-2016)

Plurality and societal values

• Evidence of plurality in preferences and perspectives

• Policy dilemmas and possible directions

• Future research agenda

TERMS value values viewpoints

preferences principles perspectives

METHODS

willingness to pay Q methodology depth interviews

choice exercises Q-to-survey methods focus groups

person trade off… … citizens juries..

Societal values: terms and methods

Measureable

Quantitative

Aggregation

Narrative

Qualitative

Individual

NICE End of life supplementary

guidance 2009

Specific criteria

• less than 2 years to live

• treatments would result in a gain of at least 3 months of increased life expectancy

• drug is licensed for a relatively small patient group

Legitmacy and societal values

• “The Institute recognises that the public,

generally, places special value on treatments

that prolong life – even for a few months – at

the end of life, as long as that extension of life is

of reasonable quality (at least pain-free if not

disability-free). NICE has therefore provided its

advisory bodies with supplementary advice about

the circumstances under which they should

consider advising, as cost-effective, treatments

costing >£30,000 per QALY.”

Rawlins et al Brit j of Clinical Pharmacology 2010 p 348

Research evidence since 2009

…is mixed!

Using Q methodology to investigate societal

viewpoints and the relative value of life extension for

patients with terminal illness

MRC Methodology Panel funding 2011-2014 Rachel Baker, Helen Mason, Neil McHugh, Cam Donaldson, Laura Williamson, Jon Godwin, (GCU) Marissa Collins, Rohan Deogaonkar Job van Exel (Erasmus, Rotterdam) Cathy Hutchinson (Beatson Cancer Centre)

Using Q methodology to investigate societal

viewpoints and the relative value of life extension for

patients with terminal illness

Using Q methodology to investigate societal

viewpoints and the relative value of life extension for

patients with terminal illness

www.gcu.ac.uk/endoflife

Q Methodology

FACTOR A

FACTOR B

FACTOR C

Three perspectives on the relative value of life

extension at the end of life

V3: “Valuing wider benefits and opportunity cost – the quality of life and death”

V1: “A population perspective – value for money, no special cases .”

V2: “Life is precious – valuing life-extension and patient choice”

23

Q-to-Survey (Q2S) findings

Viewpoint Number of

respondents %

1 1808 37

2 2416 49

3 456 9

MIXED 231 5

TOTAL

4911

100

24

Quantitative evidence of plurality

25

Dilemma – incorporating (plural) societal

values into policies and decisions?

1. Majoritarian approaches

2. Ethical analysis (and the role of societal values?)

3. Deliberative methods (and the role of societal

values?)

4. Critical analysis of societal values - consistency and

consensus in empirical data (principles, policies,

patients)

Dilemma – incorporating (plural) societal

values into policies and decisions?

1. Majoritarian approaches

2. Ethical analysis (and the role of societal values?)

3. Deliberative methods (and the role of societal

values?)

4. Critical analysis of societal values - consistency

and consensus in empirical data (principles,

policies, patients)

High level PRINCIPLES Theory

Mid level POLICIES Operation

Low level PATIENTS Case

Multi-level study of social values and resource allocation in health care

Dilemma – incorporating (plural) societal

values into policies and decisions?

1. Majoritarian approaches

2. Ethical analysis (and the role of societal values?)

3. Deliberative methods (and the role of societal

values?)

4. Critical analysis of societal values - consistency

and consensus in empirical data (principles,

policies, patients)

Thank you!

rachel.baker@gcu.ac.uk