Does the Process of Deliberation Change Individuals' Health State Valuations? An Exploratory Study Using the Person Trade-Off Technique

Background: This article explores two gaps in the health state valuation literature: the effect of processes and the stability of health state valuations, and the existence of preexisting valuations. Stability in health state valuations over time depends on whether preferences are considered to be preexisting (axiom of completeness) and therefore can be gathered reliably, or are constructed during consideration and debate. Under the former, changes in revealed preferences are evidence of poor reliability; under the latter, it is a function of the deliberative process. Methods: This study explores the effect of deliberation on health state valuations elicited by using the person trade-off technique. Quantitative analysis was used to explore whether respondents changed their responses following deliberation and the impact of change on aggregate health state values. Qualitative methods were used to explore respondents' views on the elicitation process and the impact of deliberation on their responses. Results: Following discussion and deliberation, 74% of the participants changed their person trade-off valuations and this did have an impact on the aggregate valuations. The qualitative analysis lends some support to the construction of preference assumption. Conclusions: The results from this exploratory study challenge the notion that individuals have preexisting health state preferences and call for further detailed research in this area. Furthermore, it raises concerns over current practices around preference elicitation exercises, which have tended to be carried out as a solitary exercise without allowing time for respondents to reflect and deliberate on their decisions.