The value of health—Empirical issues when estimating the monetary value of a quality-adjusted life year based on well-being data

Sebastian Himmler*, Jannis Stöckel*, Job van Exel, Werner B.F. Brouwer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Decisions on interventions or policy alternatives affecting health can be informed by economic evaluations, like cost-benefit or cost-utility analyses. In this context, there is a need for valid estimates of the monetary equivalent value of health (gains), which are often expressed in € per quality-adjusted life years (QALYs). Obtaining such estimates remains methodologically challenging, with a recent addition to the health economists' toolbox, which is based on well-being data: The well-being valuation approach. Using general population panel data from Germany, we put this approach to the test by investigating several empirical and conceptual challenges, such as the appropriate functional specification of income utility, the choice of health utility tariffs, or the health state dependence of consumption utility. Depending on specification, the bulk of estimated € per QALY values ranged from €20,000–60,000, with certain specifications leading to more considerable deviations, underlining persistent practical challenges when applying the well-being valuation methodology to health and QALYs. Based on our findings, we formulate recommendations for future research and applications.

Original languageEnglish
Pages (from-to)1849-1870
Number of pages22
JournalHealth Economics (United Kingdom)
Issue number8
Publication statusAccepted/In press - 5 May 2021

Bibliographical note

Funding Information:
We would like to thank two anonymous reviewers for their insightful and constructive comments. Further we would like to thank participants and especially discussants at the Nordic Health Economists' study group meeting 2019, the EuHEA PhD conference 2019, the 2019 International Health Economics Congress and the 2019 meeting of the German Health Economics Association. We further would like to thank Dorte Gyrd‐Hansen and Tom Stargardt for excellent comments on a previous version of this paper. Analogous to the functioning of a hydraulic pump, the consistent input pressure on this work, exerted by all mentioned parties, enabled us to produce continuous and sustained output (improvements). Sebastian Himmler receives funding from a Marie Sklodowska‐Curie fellowship nanced by the European Commission (Grant agreement No. 721402) and Jannis StŁockel receives funding from the Erasmus Initiative Smarter Choices for Better Health of the Erasmus University Rotterdam. All remaining errors are our own.

Publisher Copyright:
© 2021 The Authors. Health Economics published by John Wiley & Sons Ltd.


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