"Death" and the valuation of health-related quality of life

BACKGROUND AND OBJECTIVES. Despite evidence to the contrary, a common assum ption in the area of health status measurement is that the state "dead" is the worst possible health state and by definition should be assigned a valu e of 0. However, the value of the state "dead" and the notion of states wor se than "dead" have never been fully addressed as a research topic. This ar ticle demonstrates the extent of the variation in the value given to the st ate "dead" by individuals and the effects of transformation on individual a nd aggregate values using data elicited with 2 methods (visual analog scale rating and ranking) that place no constraint on the value given to the sta te "dead." RESEARCH DESIGN. Face-to-face interviews were conducted with 253 adults in North Yorkshire, UK in 1998. Each participant performed ranking and visual analog scale rating exercises for 19 EuroQol EQ-5D health states. CONCLUSIONS AND RESULTS. Data showed that there is a small group of individ uals who, when given the option, choose to place relatively high value on t he state "dead" compared with other health states. This did not appear to b e due to artifact. Evidence also suggested that the usual assumptions under lying the transformation of health state values, for which the distance bet ween full health and "dead" is used to define the denominator, may not hold for these individuals and may distort aggregate preference structures. The authors stress the need for more systematic inquiry in this field.