Social Time Preferences for Health and Money Elicited with a Choice Experiment

Authors

  • Willem Jan Meerding PhD,

    Corresponding author
    1. Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands;
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  • Gouke J. Bonsel MD, PhD,

    1. Department of Health Policy and Management, Erasmus Medical Center, Rotterdam, The Netherlands;
    2. Department of Social Medicine, Academic Medical Center, Amsterdam, The Netherlands
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  • Werner B. F. Brouwer PhD,

    1. Department of Health Policy and Management, Erasmus Medical Center, Rotterdam, The Netherlands;
    2. Institute for Medical Technology Assessment, Erasmus Medical Center, Rotterdam, The Netherlands;
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  • Marja C. Stuifbergen PhD,

    1. Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands;
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  • Marie-Louise Essink-Bot MD, PhD

    1. Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands;
    2. Department of Social Medicine, Academic Medical Center, Amsterdam, The Netherlands
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Willem Jan Meerding, Pfizer bv, P.O. Box 37, 2900 AA Capelle a/d IJssel, The Netherlands. E-mail: Willemjan.Meerding@pfizer.com

ABSTRACT

Objectives:  In economic evaluations future health and monetary outcomes are commonly discounted at equal and constant rates. The theoretical foundation of this practice is being debated and appropriate discount rates for costs and health effects are sought. Here, we have derived social discount rates for health, money, and environmental benefits by means of a choice experiment.

Methods:  All choices were framed from a social perspective. We investigated differences in time preference by domain (health, monetary benefits, environmental benefits), time delay (5, 10, and 40 years), and respondent characteristics. Respondents were 173 health-care professionals and 34 health policymakers. Choice titration was used to determine when the respondent was indifferent between future and present benefits.

Results:  At least two-thirds of respondents preferred an intervention with immediate benefits to delayed benefits in the different domains. The median (mean) yearly discount rates for health benefits were 2.7% (10.7%), 1.3% (3.5%), and 1.1% (2.3%) assuming a 5, 10, and 40 years delay, respectively. Social time preference for monetary benefits was significantly stronger, with median (mean) yearly discount rates of 6.6% (18.7%) and 4.8% (11.2%) assuming a 5 and 10 years delay, respectively. The social time preference with regard to environmental benefits was similar to the monetary benefits. Social time preference for the different domains was significantly correlated at the individual level.

Conclusions:  The empirically derived social time preference is in line with current theoretical arguments for a lower discount rate for health benefits than for monetary benefits. Moreover, the implied median discount rates for health were lower than those commonly used or advocated in guidelines.

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