TRADING LIFE AND HEALTH FOR OTHER GOALS

Purpose: To measure the degree to which people express willingness to trade life years or health status for non-medical life goals.

Method: In three studies, ambulatory patients provided important life goals. In Study 1, patients performed time-tradeoff between life years and goal achievement and made choices between life conditions that varied in goal achievement, life expectancy, and disability; in Study 2, patients made a series of choices that traded off health state (their own and a set of HUI marker states with previously published norms) and goal achievement; in Study 3, patients performed standard time tradeoff assessments in several different goal achievement contexts.

Results: In Study 1, participants reported considerable willingness to trade life years for goal achievement, trading, on average, 71% of their remaining life for certain achievement vs. certain non-achievement or 54% of their remaining life for their expected likelihood of achievement vs. non-achievement. Participants were most willing to trade life years for family goals and least willing for wealth goals. In the paired comparisons, life expectancy, disability status, and goal achievement each had a significant main effect by ANOVA, with small but significant interactions between goal achievement and disability and goal achievement and life expectancy. A conjoint analysis of the stimuli found that goal achievement was 1.5 times as important as avoiding deafness and 1.9 times as important as gaining 5 life years.

In Study 2, participants equally preferred a moderately impaired health state with goal achievement to perfect health without goal achievement and more strongly preferred the moderately impaired state with goal achievement than other less impaired states without goal achievement. Controlling for goal achievement, participants were appropriately sensitive to the quality of the health states, with strong correlations (r>0.98) between rankings derived from choices and HUI scores.

Study 3 demonstrated that the mere discussion of goals and goal achievement in the context of a standard time tradeoff assessment (without trading off goals) did not impact the assessment.

Conclusions: Non-medical life goals are important determinants of quality of life. People express willingness to trade off significant quantity of life or quality of health in pursuit of their goals. However, standard time tradeoff assessments and the QALY measurements that result therefrom may not incorporate the compensatory relationship between life, health, and goals.