Reference-dependent age weighting of quality-adjusted life years

Arthur E. Attema*, Werner B.F. Brouwer, Jose Luis Pinto-Prades

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
53 Downloads (Pure)


People do not only care about maximizing health gains but also about their distribution. For example, they give more weight to younger patients than older patients. This pilot study aims to investigate if age weighting is reinforced by loss aversion if young people are falling behind one's perceived ‘normal’ quality of life (QoL), while older people do not. We apply a person trade-off method in a large representative sample (n = 990) to estimate age weighting factors. We also measure QoL levels that individuals regard as ‘normal’ for different ages, serving as reference points. We observe a considerable amount of age weighting, with 20-year-old patients on average receiving 1.7 times as much weight as 80-year-old patients. Perceived ‘normal’ QoL rapidly decreases with age of a patient. Older people are more optimistic about what constitutes ‘normal QoL’ than younger people, but they express a faster decline in normal QoL due to aging. Respondents who view all improvements to be gain enlarging show the least age weighting, but loss aversion cannot explain the results. Still, one's age-related reference level is an important predictor of age weights. Given the explorative nature of this study, further studies are called for to generate more robust evidence.

Original languageEnglish
Pages (from-to)2515-2536
Number of pages22
JournalHealth Economics (United Kingdom)
Issue number12
Early online date4 Sept 2022
Publication statusPublished - Dec 2022

Bibliographical note

Funding Information:
This research was made possible through a grant from The Netherlands Organization for Health Research and Development (ZonMW), project number 152002041.

Publisher Copyright:
© 2022 The Authors. Health Economics published by John Wiley & Sons Ltd.


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