A comparative ethical analysis of the Egyptian clinical research law

BACKGROUND

In this study, we examined the ethical implications of Egypt's new clinical trial law, employing the ethical framework proposed by Emanuel et al. and comparing it to various national and supranational laws. This analysis is crucial as Egypt, considered a high-growth pharmaceutical market, has become an attractive location for clinical trials, offering insights into the ethical implementation of bioethical regulations in a large population country with a robust healthcare infrastructure and predominantly treatment-naïve patients.

METHODS

We conducted a comparative analysis of Egyptian law with regulations from Sweden and France, including the EU Clinical Trials Regulation, considering ethical human subject research criteria, and used a directed approach to qualitative content analysis to examine the laws and regulations. This study involved extensive peer scrutiny, frequent debriefing sessions, and collaboration with legal experts with relevant international legal expertise to ensure rigorous analysis and interpretation of the laws.

RESULTS

On the rating of the seven different principles (social and scientific values, scientific validity, fair selection of participants, risk-benefit ratio, independent review, informed consent and respect for participants) Egypt, France, and EU regulations had comparable scores. Specific principles (Social Value, Scientific Value, and Fair selection of participants) were challenging to directly identify due to certain regulations embodying 'implicit' principles more than explicitly stated ones.

CONCLUSION

The analysis underscores Egypt's alignment with internationally recognized ethical principles, as outlined by Emanuel et al., through its comparison with French, Swedish, and EU regulations, emphasizing the critical need for Egypt to continuously refine its ethical regulations to safeguard participant protection and research integrity. Key issues identified include the necessity to clarify and standardize the concept of social value in research, alongside concerns regarding the expertise and impartiality of ethical review boards, pointing towards a broader agenda for enhancing research ethics in Egypt and beyond.

Guiding decisions on the future of dams: A GIS database characterizing ecological and social considerations of Dam decisions

In the United States and elsewhere, there are a growing number of dams which have exceeded their design life and will need to be repaired or removed in the coming decades. Most of these dams no longer serve their original purpose and removal can provide ecological benefits and eliminate future maintenance costs and hazards. However, many decision-makers have been ill-prepared by community resistance to proposals to remove dams. Given the number of dam removal initiatives that have failed or been delayed due to community resistance, both ecological and social attributes of dams need to be better mapped and conveyed in understandable ways. The goal of this study was to support future decisions regarding dams by 1) developing a set of metrics to assess the social and ecological dimensions of dams, and 2) using these metrics to develop a GIS database, for the 1000+ dams in the Narragansett Bay/Rhode Island area of southern New England. The database characterizes the ecological benefits of dam removal or modification, in terms of fish passage, and the social dimensions that may need to be considered when engaging a community in discussions about the future of a dam. Our emphasis was on small-head dams (i.e. <5 m tall) which comprise most dams in the study area. We created social value metrics that used GIS data to assess dams and their impoundments for potential benefits to waterfront properties, history, sense-of-place, and recreation. We modeled our ecological metrics and ranking system after the Nature Conservancy's Northeast Aquatic Connectivity study which considered factors relating to river connectivity and watershed quality. We evaluated our social and ecological metrics using case studies of dams in the study area that had been previously removed or modified. We assumed that both sets of dams were ecologically important, but the modified dams had higher social value that prohibited their removal. Dams that had been removed or modified were both ranked as high priority in terms of value for fish passage, particularly for diadromous fish. Dams that were modified to include fish passage had substantially larger impoundments, more waterfront properties, and more features associated with recreational or cultural value (e.g. boating opportunity, visibility, etc.). Our social metrics were consistent with expectations based on the limited case studies (7 removals, 19 modifications) available in the study area. We made the dam assessment metrics readily accessible to stakeholders through an interactive ArcGIS Online web map.

Advancing the social return on investment framework to capture the social value of public health interventions: semistructured interviews and a review of scoping reviews

OBJECTIVES

Investment in public health has far-reaching impacts, not only on physical health but also on communities, economies and the environment. There is increasing demand to account for the wider impact of public health and the social value that can be created, which can be captured through the use of the social return on investment (SROI) framework. This study aims to explore the application of SROI and identify areas of advancement for its use in public health.

STUDY DESIGN AND METHODS

Publically available SROI studies of public health interventions previously identified through published systematic scoping reviews were examined through a methodological lens. This was complemented by semistructured interviews with key public health academic experts with experience in the field of SROI. The results were thematically analysed and triangulated.

RESULTS

In total, 53 studies and nine interviews were included in the analysis. All interviewees agreed that SROI is a suitable framework to demonstrate the social value of public health interventions. Developmental aspects were also identified through the analysis. This included a more systematic use of SROI principles and methodological developments. Lastly, it was identified that further advancements were needed to promote awareness of SROI and how it can be used to generate investment.

CONCLUSION

By identifying key areas for advancement, the results from this study can be used to further refine the SROI framework for use within the speciality to promote investment in services and interventions that demonstrate maximum value to people, communities, economies and the environment.

Identifying sustainability priorities among value chain actors in artisanal common octopus fisheries

The United Nations (UN) Decade of Ocean Science highlights a need to improve the way in which scientific results effectively inform action and policies regarding the ocean. Our research contributes to achieving this goal by identifying practical actions, barriers, stakeholder contributions and resources required to increase the sustainability of activities carried out in the context of artisanal fisheries to meet UN Sustainable Development Goals (SDG) and International Year of Artisanal Fisheries and Aquaculture (IYAFA) Global Action Plan (GAP) Pillar targets. We conducted a novel 'social value chain analysis' via a participatory workshop to elicit perspectives of value chain actors and fisheries stakeholders associated with two Spanish artisanal common octopus (Octopus vulgaris) fisheries (western Asturias-Marine Stewardship Council [MSC] certified, and Galicia-non-MSC certified) about their priorities regarding sustainable octopus production and commercialization. Our adapted Rapfish sustainability framework emphasised the importance of economic, environmental, ethical, institutional, social, and technological indicators to different actors across the value chain. We mapped participants' shared sustainability priorities (e.g. integrated fisheries management, knowledge-based management, product traceability) to six Rapfish indicators, seven IYAFA Pillars and twelve SDGs to reveal how our results can inform ocean policy and actions. This identified how certification incentives and other cooperative approaches can facilitate environmental, economic and social sustainability (e.g. value-added products, price premiums for producers, gender inclusive organisations); support IYAFA priority outcomes (raised awareness, strengthened science-policy interface, empowered stakeholders, partnerships); and help to achieve UN SDG targets (e.g. SDG 14.b, SDG 17.17). The results can inform actors, stakeholders and policymakers about how different actors contribute to efforts to achieve the SDGs and how to manage priorities for sustainable actions within artisanal fisheries and their value chains. We recommend inclusive and equitable participatory knowledge transfer and governance platforms as part of the UN Decade of Ocean Science and beyond where participants can create theories of change towards sustainability involving the development of multi-sectoral ocean policies framed at the level of the value chain and supported by appropriate governance structures.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s11160-023-09768-5.

Social value, normative features and gender differences associated with speeding and compliance with speed limits

INTRODUCTION

Among risky driving behaviors, speeding is a main causal and aggravating factor of road crashes and is more frequent among males than females. Research suggests that this gender gap could be explained by gender social norms that lead males to assign more social value to speeding than females. However, few studies have proposed directly investigating gendered prescriptive norms associated with speeding. We propose to address this gap through two studies based on the socio-cognitive approach to social norms of judgment.

METHODS

Study 1 (N = 128, within-subject design) investigated the extent to which speeding is subject to social valuation among males, compared to females, through a self-presentation task. Study 2 (N = 885, between-subject design) aimed to identify the dimension of social value (i.e., social desirability, social utility) that both genders associate with speeding, based on a judgment task.

RESULTS AND CONCLUSION

Although results of study 1 indicate that both genders devaluate speeding and valuate speed limits compliance, we found that males do so to a lesser extent than females. Results of study 2 further suggest that males less valuate speed limit compliance than females on the social desirability dimension, while no gender difference were found in valuation of speeding on both dimensions of social value. Regardless of gender, results also indicate that speeding is valued more on the social utility than on the social desirability dimension, while speed limit compliance is valued similarly on both dimensions.

PRACTICAL APPLICATIONS

Road safety campaigns toward males could benefit to focus more on enhancing the representations of speed compliant drivers, in terms of social desirability, than devaluing the representation of speeding drivers.

Estimating a social value set for EQ-5D-5L in Sweden

BACKGROUND

The study aims to elicit a value set based on the EQ-VT for the EQ-5D-5L that can be used to support decision-making in Sweden.

METHODS

Participants were recruited from the general population based on age, sex and urban/rural area quota sampling from five regions across Sweden. In total, 785 interviews were conducted from February 2020 to April 2021 using the EQVT 2.1 protocol, and both composite time trade-off (c-TTO) and discrete choice experiments (DCE) were used to elicit health preferences. A variety of models have been tested for the c-TTO data (generalized least square, Tobit, heteroskedastic models) and DCE data (conditional logit model), as well as the combined c-TTO and DCE data (hybrid modelling). Model selection was based on theoretical considerations, logical consistency of the parameter estimates, and significance of the parameters (p = 0.05). Model goodness-of-fit was assessed by AIC and BIC, and prediction accuracy was assessed in terms of mean absolute error. The predictions for the EQ-5D-5L health states between models were compared using scatterplots.

RESULTS

The preferred model for generating the value set was the heteroskedastic model based on the c-TTO data, with the health utilities ranging from -0.31 for the worst (55,555) to 1 for the best (11111) EQ-5D-5L states.

CONCLUSION

This is the first c-TTO-based social value set for the EQ-5D-5L in Sweden. It can be used to support the health utility estimation in economic evaluations for reimbursement decision making in Sweden.

Pricing the priceless child 2.0: children as human capital investment

This article takes Viviana Zelizer's (1985) Pricing the Priceless Child to the new millennium. Zelizer documented the transformation between the 19th and 20th century from an "economically useful" to an "emotionally priceless" child. She observed that by the 1930s, American children were practically economically worthless but invested with significant emotional value. What has happened to this emotionally priceless child at the dawn of the new millennium? Has there been a new transformation in the social value of children, and, if so, what might have such a transformation entailed? To address these questions, we examine overtime trends that point to increasing devotion of resources and time to children's education, a key input in the exceedingly influential human capital theory, which connects investment into children's human capital with their future market value. Therefore, we argue that the priceless child 2.0 is a useful-to-be human capital investment child. We use four empirical examples of overtime growth in children's human capital investment: (a) enrollments in early childhood education, (b) federal spending on early education, (c) federal spending on K-12 programs, and (d) parental spending on child care, education and extracurricular activities. In the conclusion, we discuss some potential consequences and concerns about raising children as human capital investment.

Operative public values as a tool for healthcare decisions: the social value and clinical criteria of triage

With the current pandemic, many scholars have contended that clinical criteria offer the best way to implement triage. Further, they dismiss the criteria of social value as a good one for triage. In this paper, I respond to refute this perspective. In particular, I present two sets of arguments. Firstly, I argue that the objections to the social value criteria they present apply to the clinical criteria they favor. Secondly, they exaggerate the negative aspects of the social value criteria, while I suggest it is reasonable to use this. I end the article by recommending how operative public values can be a good way to make triaging decisions.

Color me impressed: A partner's target feature captures visual attention

Attending to a target is more difficult in the presence of a salient distractor. The present study investigated whether social value can modulate the extent to which distractors capture attention. Two participants sitting side-by-side performed a visual search task in cooperative and competitive conditions. Search displays contained either both targets, one target and a neutral stimulus or an ambiguous and a neutral stimulus. Results showed that agents took longer to respond to targets presented together with the partner's target compared to a neutral stimulus of equal salience. Agents also produced more false alarms in response to stimuli whose color lay between their own and the partner's target color compared to stimuli lying between the colors of their target and a neutral stimulus. These results suggest that stimuli with features relevant to a partner can capture attention more than neutral but equally salient stimuli, indicating that social value affects selective attention in a similar way as task goals and selection history.

The relative value of carer and patient quality of life: A person trade-off (PTO) study

Carer quality of life is increasingly considered alongside patient quality of life in economic evaluation. Important questions remain about how to value carer and patient quality of life effects alongside one another. In this study, we estimated the relative social value of two conceptualisations of carer quality of life (health-related and care-related) compared to patient quality of life. Relative valuations were estimated using a person trade-off (PTO) study with 990 representative members of the UK public. Participants chose between hypothetical services that improved the quality of life of carers and patients, iterating to a point of indifference. Overall 84% of participants completing the task were willing to trade patient and carer quality of life effects. Relative to a reference point of 1 for patient health-related quality of life, we estimated a social value of 0.74 for carer health-related quality of life effects and 0.69 for carer care-related quality of life effects. In conclusion, public preferences appear to support the inclusion of carer quality of life effects within economic evaluation. The results provide a means to value different carer quality of life outcomes in economic evaluation, where such values are needed and deemed appropriate.

Ecosystem services in urban ecological infrastructure of Latin America and the Caribbean: How do they contribute to urban planning?

We developed a conceptual framework that describes the key role of ecosystem services in urban ecological infrastructure. From this framework we analyze how research on ecosystem services has been addressed in cities of Latin America and the Caribbean, in order to discuss their incorporation into policies of urban planning, in the context of nature-based solutions and sustainable development goals. Mexico, Brazil, Chile, Colombia and Argentina represent 90% of research in urban ecosystem services, all of them except Colombia had carried out studies considering green, blue and gray-hybrid infrastructures. However, green-hybrid infrastructure clustered most of the studies. Ecosystem service supply component and intermediate beneficiaries are the most studied. Our results show that most studies have not been developed from the perspective of the biophysical, sociocultural or economic assessment of ecosystem services, on the contrary we recognized or deduced them from proxy variables found within the studies. Our findings suggest that the study of urban ecosystem services in Latin America and the Caribbean is in development and has begun to increase in the last decade. However, we found that the incorporation of urban ecosystem services in urban planning is low, but at the same time, it is in a promising development related to the application of innovative actions such as nature-based solutions and in support of the new global urban agenda.

The social value of investing in public health across the life course: a systematic scoping review

Background

Making the case for investing in public health by illustrating the social, economic and environmental value of public health interventions is imperative. Economic methodologies to help capture the social value of public health interventions such as Social Return on Investment (SROI) and Social Cost-Benefit Analysis (SCBA) have been developed over past decades. The life course approach in public health reinforces the importance of investment to ensure a good start in life to safeguarding a safe, healthy and active older age. This novel review maps an overview of the application of SROI and SCBA in the existing literature to identify the social value of public health interventions at individual stages of the life course.

Methods

A systematic scoping review was conducted on peer-reviewed and grey literature to identify SROI and SCBA studies of public health interventions published between January 1996 and June 2019. All primary research articles published in the English language from high-income countries that presented SROI and SCBA outputs were included. Studies were mapped into stages of the life course, and data on the characteristics of the studies were extracted to help understand the application of social value methodology to assess the value of public health interventions.

Results

Overall 40 SROI studies were included in the final data extraction, of which 37 were published in the grey literature. No SCBA studies were identified in the search. Evidence was detected at each stage of the life course which included; the birth, neonatal period, postnatal period and infancy (n = 2); childhood and adolescence (n = 17); adulthood (main employment and reproductive years) (n = 8); and older adulthood (n = 6). In addition, 7 studies were identified as cross-cutting across the life course in their aims.

Conclusion

This review contributes to the growing evidence base that demonstrates the use of social value methodologies within the field of public health. By mapping evidence across stages of the life course, this study can be used as a starting point by public health professionals and institutions to take forward current thinking about moving away from traditional economic measures, to capturing social value when investing in interventions across the life course.

Social value of a set of proposals for the ideal approach of multiple sclerosis within the Spanish National Health System: a social return on investment study

BACKGROUND

Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease that in many cases produces disability, having a high impact in patients' lives, reducing significantly their quality of life. The aim of this study was to agree on a set of proposals to improve the current management of MS within the Spanish National Health System (SNHS) and apply the Social Return on Investment (SROI) method to measure the potential social impact these proposals would create.

METHODS

A Multidisciplinary Working Team of nine experts, with representation from the main stakeholders regarding MS, was set up to agree on a set of proposals to improve the management of MS. A forecast SROI analysis was carried out, with a one-year timeframe. Data sources included an expert consultation, a narrative literature review and a survey to 532 MS patients. We estimated the required investment of a hypothetical implementation, as well as the potential social value that it could create. We calculated outcomes in monetary units and we measured intangible outcomes through financial proxies.

RESULTS

The proposed ideal approach revealed that there are still unmet needs related to MS that can be addressed within the SNHS. Investment would amount to 148 million € and social return to 272 million €, so each euro invested could yield almost €2 of social return.

CONCLUSIONS

This study could guide health interventions, resulting in money savings for the SNHS and increases in patients' quality of life.

The Effects of Social Class on Individuals' Decision-Making Tendencies in a Prestige-Money Game: Social Value or Instrumental Value?

Through a series of three experiments, this study explored the possible influence of social class on the decision-making tendency of prestige-seeking in a Prestige-Money Game, and further explored the internal sources of such influence. In Experiment 1, the participants' social class was manipulated to examine whether there were class effects in prestige-seeking when individuals of different social classes were paired together in a Prestige-Money Game. In Experiment 2, social rank, which only contained ranking differences, was adopted as a more abstract proxy variable for social class to investigate whether class effects still existed in prestige-seeking in a Prestige-Money Game. Based on the results of Experiment 1 and 2, Experiment 3 further explored the sources of motivation for prestige-seeking among subjects of different social class. The results showed that upper-class individuals showed greater money-seeking tendencies when facing an upper-class opponent, and showed greater prestige-seeking tendencies when facing a lower-class opponent. Such tendencies were derived from social rank; instrumental value played a substantial role. The game strategy of lower-class individuals were mainly oriented toward their personal needs. Specifically, they showed greater prestige-seeking when facing an upper-class opponent, and showed greater money-seeking when facing a lower-class opponent. Such tendencies were derived from the activation of their social class identity; the role of instrumental value was limited. These findings suggest that the essential differences in the game tendencies of individuals from different social classes in a Prestige-Money Game may originate from the fact that different social classes have different demands for the instrumental value and social value of prestige.

Social and economic value of Portuguese community pharmacies in health care

Background

Community pharmacies are major contributors to health care systems across the world. Several studies have been conducted to evaluate community pharmacies services in health care. The purpose of this study was to estimate the social and economic benefits of current and potential future community pharmacies services provided by pharmacists in health care in Portugal.

Methods

The social and economic value of community pharmacies services was estimated through a decision-model. Model inputs included effectiveness data, quality of life (QoL) and health resource consumption, obtained though literature review and adapted to Portuguese reality by an expert panel. The estimated economic value was the result of non-remunerated pharmaceutical services plus health resource consumption potentially avoided. Social and economic value of community pharmacies services derives from the comparison of two scenarios: “with service” versus “without service”.

Results

It is estimated that current community pharmacies services in Portugal provide a gain in QoL of 8.3% and an economic value of 879.6 million euros (M€), including 342.1 M€ in non-remunerated pharmaceutical services and 448.1 M€ in avoided expense with health resource consumption. Potential future community pharmacies services may provide an additional increase of 6.9% in QoL and be associated with an economic value of 144.8 M€: 120.3 M€ in non-remunerated services and 24.5 M€ in potential savings with health resource consumption.

Conclusions

Community pharmacies services provide considerable benefit in QoL and economic value. An increase range of services including a greater integration in primary and secondary care, among other transversal services, may add further social and economic value to the society.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2525-4) contains supplementary material, which is available to authorized users.

How important is severity for the evaluation of health services: new evidence using the relative social willingness to pay instrument

The 'severity hypothesis' is that a health service which increases a patient's utility by a fixed amount will be valued more highly when the initial health state is more severe. Supporting studies have employed a limited range of analytical techniques and the objective of the present paper is to test the hypothesis using a new methodology, the Relative Social Willingness to Pay. Three subsidiary hypotheses are: (1) that the importance of the 'severity effect' varies with the type of medical problem; (2) that the relationship between value and utility varies with the severity of the initial health state; and (3) that there is a threshold beyond which severity effects are insignificant. For each of seven different health problems respondents to a web-based survey were asked to allocate a budget to five services which would, cumulatively, move a person from near death to full health. The time trade-off utilities of health states before and after the service were estimated. The social valuation of the service measured by the budget allocation was regressed upon the corresponding increase in utility and severity as measured by the pre-service health state utility. Results confirm the severity hypothesis and support the subsidiary hypotheses. However, the effects identified are quantitatively significant only for the most severe health states. This implies a relatively limited redistribution of resources from those with less severe to those with more severe health problems.

Estimating the future burden of cardiovascular disease and the value of lipid and blood pressure control therapies in China

BACKGROUND

Lifestyle and dietary changes reflect an ongoing epidemiological transition in China, with cardiovascular disease (CVD) playing an ever-increasing role in China's disease burden. This study assessed the burden of CVD and the potential value of lipid and blood pressure control strategies in China.

METHODS

We estimated the likely burden of CVD between 2016 and 2030 and how expanded use of lipid lowering and blood pressure control medication would impact that burden in the next 15 years. Accounting for the costs of drug use, we assessed the net social value of a policy that expands the utilization of lipid and blood pressure lowering therapies in China.

RESULTS

Rises in prevalence of CVD risk and population aging would likely increase the incidence of acute myocardial infarctions (AMIs) by 75 million and strokes by 118 million, while the number of CVD deaths would rise by 39 million in total between 2016 and 2030. Universal treatment of hypertension and dyslipidemia patients with lipid and blood pressure lowering therapies could avert between 10 and 20 million AMIs, between 8 and 30 million strokes, and between 3 and 10 million CVD deaths during the 2016-2030 period, producing a positive social value net of health care costs as high as $932 billion.

CONCLUSIONS

In light of its aging population and epidemiological transition, China faces near-certain increases in CVD morbidity and mortality. Preventative measures such as effective lipid and blood pressure management may reduce CVD burden substantially and provide large social value. While the Chinese government is implementing more systematic approaches to health care delivery, prevention of CVD should be high on the agenda.

Re-conceiving building design quality: A review of building users in their social context

Considerable overlap exists between post-occupancy research evaluating building design quality and the concept of 'social value', popularised by its recent application to issues of the public realm. To outline this potential research agenda, the paper reviews design quality research on buildings in relation to users and their social context where the term 'social context' refers to building user group dynamics, a combination of organisational cultures, management strategies, and social norms and practices. The review is conducted across five key building types, namely housing, workplaces, healthcare, education, and the retail/service sector. Research commonalities and gaps are identified in order to build a more comprehensive picture of the design quality literature and its handling of users in their social context. The key findings concerning each building type are presented visually. It is concluded that the design quality field comprises a patchwork of relatively isolated studies of various building types, with significant potential for theoretical and empirical development through interdisciplinary collaboration. Users tend to be conceived as anonymous and autonomous individuals with little analysis of user identity or interaction. Further, the contextual impact of user group dynamics on the relationship between building design and building user is rarely addressed in the literature. Producing a more nuanced understanding of users in situ is proposed as an important area for future design quality research.

[Factors related to nurses' patient identification behavior and the moderating effect of person-organization value congruence climate within nursing units]

PURPOSE

This research was an empirical study designed to identify precursors and interaction effects related to nurses' patient identification behavior. A multilevel analysis methodology was used.

METHODS

A self-report survey was administered to registered nurses (RNs) of a university hospital in South Korea. Of the questionnaires, 1114 were analyzed.

RESULTS

The individual-level factors that had a significantly positive association with patient identification behavior were person-organization value congruence, organizational commitment, occupational commitment, tenure at the hospital, and tenure at the unit. Significantly negative group-level precursors of patient identification behavior were burnout climate and the number of RNs. Two interaction effects of the person-organization value congruence climate were identified. The first was a group-level moderating effect in which the negative relationship between the number of RNs and patient identification behavior was weaker when the nursing unit's value congruence climate was high. The second was a cross-level moderating effect in which the positive relationship between tenure at the unit and patient identification behavior was weaker when value congruence climate was high.

CONCLUSION

This study simultaneously tested both individual-level and group-level factors that potentially influence patient identification behavior and identified the moderating role of person-organization value congruence climate. Implications of these results are discussed.

Concerns for severity in priority setting in health care: a review of trade-off data in preference studies and implications for societal willingness to pay for a QALY

OBJECTIVE

In a wide range of health care jurisdictions, to give priority to the severely ill over the less severely ill is important in decisions about resource allocation across patient groups. We summarise data on concerns for severity measured at a cardinal level in preference studies in various countries and show how the data may provide guidance for determining severity graded willingness to pay for a QALY.

METHODS

We review evidence in 15 articles published in peer reviewed journals in the time period 1978-2010, with reports from altogether 20 individual studies in 9 different countries. The studies all focus on the quality of life dimension of severity, i.e. utility losses on the 0-1 scale used in QALY-calculations. We report 116 individual observations of paired comparisons of utility improvements with different start levels. We argue that the strength of concerns observed on the quality of life dimension may be assumed to apply also to losses in length of life and thus to severity in terms of proportional shortfall of QALYs. By means of regression analyses we estimate a severity gradient in each study that suggests the span in societal willingness to pay for a QALY to people at high and low levels of severity respectively.

RESULTS

Concerns for severity show up quite strongly across countries, sample types and question framings, although the size of the severity gradient varies very much. Interested policy makers may hopefully find the central tendency in the results to be useful as an input to determining severity dependent willingness to pay for a QALY.