Contingent valuation: (still) on the road to nowhere?

✍ Scribed by Richard D. Smith; Tracey H. Sach

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 69 KB
• Volume: 18
• Category: Article
• ISSN: 1057-9230
• DOI: 10.1002/hec.1527

✦ Synopsis

In this journal in 2001 Olsen and Smith, after systematically reviewing empirical contingent valuation (CV) studies in healthcare, had 'the distinct feeling of a huge mismatch between the theoretical glory of willingness-to-pay and the usefulness for public health policy of the majority of surveys which have applied this method' (Olsen and Smith, 2001, p. 47). Since then, there has continued to be an increase in the number of CV studies being published and their scope of application; from one or two per year in the late 1980s to 38 in 2005, conducted in more than 35 countries and across a wide spectrum of clinical/ disease areas and intervention types (Sach et al., 2007). It seems fair then to ask in light of this expansion of activity and passage of time: does this feeling still hold? Is CV (still) on a road to the 'nowhere' of policy irrelevance, or have significant advances been made to capture the theoretical glories it offers? If this feeling does still hold, why, and what may be done about it?

Olsen and Smith identified three arguments commonly advanced for using CV: (i) its welfarist foundation; (ii) no restriction on the range of benefits valued; and (iii) allowing cost-benefit analysis (CBA), and hence addressing allocative efficiency. The first of these was summarily dismissed, as the suitability of an approach depends upon it reflecting societal value judgements, which in many health systems has rejected welfarism. The second and third arguments remain potential selling points for CV, especially given expanding interest in evaluating complex public health interventions, which clearly have non-health benefits, and where costs and benefits crosssectoral boundaries. For instance, the recent drive (e.g. by the National Institute for Health and Clinical Excellence in England) toward using economic evidence in public health may force analysts and policy makers to find ways of comparing health and non-health outcomes, and thus drive them toward renewed and sustained investment in making CV methods adequately robust and practicable. Indeed, it could be that CV developments might be more usefully focussed on public health, rather than more common 'health technology assessment '. However, Olsen and Smith, and subsequent reviews (e.g. Smith 2003;Sach et al., 2007), demonstrate that there has been little, if any, development of the application of CV that would suggest capitalisation on these theoretical advantages. For instance, there has been no increase in the valuation of non-health outcomes, incorporating CV values into CBA, or directly valuing health programmes for different conditions. In practice, therefore, the theoretical benefits of CV continue not to be realised, and sadly