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KMID : 1170320230290030045
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Korean Journal of Health Economics and Policy
2023 Volume.29 No. 3 p.45 ~ p.66
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Risk preference and the value of hope in the treatment of severe illnesses
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Hong Ji-Hyung
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Abstract
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In 2018, the International Society for Pharmacoeconomics and Outcomes Research Special Task Force proposed new value elements, including the ‘value of hope’, to be considered in the United States value framework for Health Technology Assessment. The value of hope refers to potential patient preferences for treatments with a wider outcome distribution, offering the possibility of long-term survival in severe illness treatment (i.e., a long survival tail). The introduction of this element acknowledges that individuals facing dire circumstances, such as terminal cancer diagnoses, may willingly accept the risk of shortened life expectancy in the hope of becoming one of the few fortunate who achieve long-term survival. This study critically evaluates the theoretical validity and empirical evidence of the value of hope. A systematic literature search identified five empirical studies, all conducted in the US, assessing preferences between treatments with certain but limited effects and treatments with uncertain effects, especially for severe illnesses like advanced cancers. The findings revealed that respondents tended to prefer uncertain treatments when the two options offered equal or constant survivals, but preferences were also partly influenced by other factors such as survival skewness and probabilities. However, several theoretical and methodological gaps require further examination. Preferences for positive skewness may not solely reflect risk-seeking preferences, which could thereby lead to inconsistency in their direction, unlike average costs and effects. Furthermore, the ‘value of hope’ concept might not fully capture the essence of ‘hope’, and preferences before experiencing the actual outcomes (ex-ante) may differ from those after experiencing the outcomes (ex-post). There is also potential overlap with other value elements, such as the real option value. While hope plays a critical role in the treatment of severe illnesses, significantly influencing patients' prognosis and overall quality of life, further theoretical and empirical evidence is required before considering the ‘value of hope’ as an additional value element in policy decision-making.
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KEYWORD
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value of hope, uncertainty, risk preference, terminal cancer, severe illness, long-term survival
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