School of Social and Political Sciences - Theses

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    Eliciting societal preferences for non-health outcomes : A person trade-off study in the context of genetics
    Sheen, Daniel ( 2021)
    This thesis explores the willingness of Australians to trade-off health for the non-health benefits associated with a genomic test for a suspected genetic condition in a paediatric setting. This question is framed within an extra-welfarist approach to resource allocation in health policy that exclusively prioritizes health maximisation while systematically excluding non-health benefits. This practice is a value judgment which fails to account for the social costs and equity implications that excluding non-health benefits incurs. To test whether social preferences align with the health policy approach participants were placed in the role of a societal decision maker and asked to complete two iterative person trade-offs with four choices in each trade-off. A survey of 419 Australian participants, had participants trade-off families receiving the non-health benefits of a genomic test with adults receiving approximately one quality-adjusted life year (QALY) gain over four years for physical or mental health conditions. Results found that 78.9% of participants switched from their most preferred group when completing the physical health trading-off and 80.5% when completing the mental health trade-off. Using participants willingness to switch between groups as group sizes were adjusted a point of indifference was estimated. This gave a median estimated equivalence value of 1.54 genomic tests for each QALY gained, and a ratio of means estimated equivalence value of 1.29 genomic test for each physical health QALY and 1.37 genomic test for each mental health trade-off. Participants showed a clear willingness to trade direct health gains for non-health benefits under person trade-off conditions. This indicates a preference for the inclusion of non-health benefits in the assessment of health technologies to maximise social benefits and equity, in opposition to policy makers current utilitarian extra-welfarist approach of solely maximising QALY gains. Demonstrating a disconnect between policy makers preference and Australian’s preferences for maximising broader social welfare.