Who Have Been Asked to Value What? A Review of 54 `Willingness-to-Pay' Surveys in Health Care

The aims of this paper is to outline three types of arguments put forward that WTP is superior to QALYs, and to review how empirical studies adhere to their implications. The first, that WTP is the `theoretically correct' approach, because of its foundation in welfare economics, is being dismissed, as it is no argument. The second, that WTP imposes no restrictions as to which attributes of a programme people are allowed to value, makes sense. The paper will therefore focus on an inquiry into the scenario descriptions in the surveys. The third argument is the cost-benefit view that WTP can assist in improving social efficiency. We argue that it is impossible to infer from a partial WTP study (38 studies were partial) that a new programme should be funded from a given total health care budget. This we cannot tell without knowing the opportunity costs in terms of the benefits forgone from the displaced programmes.