Is silence golden? A test of the incorporation of the effects of ill-health on income and leisure in health state valuations.

The objective of the present study was to evaluate whether people include the effects of ill-health on income and leisure in quality of life valuation when the measure is silent on both. A convenience sample of 20 health professionals had to rate a health status on a visual analogue scale (VAS) without being explicitly asked to consider the effects of ill-health on income and leisure. A majority of respondents (60%) does not consider income effects and 75% does consider the effects on leisure. Explicitly asking respondents to incorporate these effects lowers the valuation. Our results indicate that whatever separation between costs and effects is preferred, using quality of life measures which are silent on income and leisure, leads to either double-counting or ignoring real costs or effects. Copyright 2005 John Wiley & Sons, Ltd.