Comparison of Individual and Group Valuation of Health State Scenarios across Communities in West Africa

Background: The correct valuation of health state scenarios is important for economic analyses, disease burden assessment and setting clinical guidelines. However, it is unclear whether we should use individual or group valuations. We aimed to compare individual and group valuations of a range of clinically and culturally relevant health state scenarios in a West African population. Methods: Seventy subjects were purposely selected from seven randomly selected communities in a health district in Burkina Faso. Subjects were presented with ten health state scenarios. The valuation of the scenarios was with a culturally adapted visual analogue scale. Fixed-effects ANOVA were used to compare individual valuations from the seven locations. A paired t-test was used to compare individual mean and group valuations. The differences in the ranking of valuations were investigated using the Spearman rank correlation coefficients. Results: On average, group valuations of the disability associated with the scenarios were higher than individual mean valuations by 20% (p = 0.00). The range of group valuations was wider than that of individual mean valuations. The differences in individual valuations of five scenarios across communities were significant (p <= 0.01). Within the communities, group and individual rankings of scenarios differed. Across five communities, they correlated significantly and positively. Conclusions: Groups valued the disability associated with health state scenarios as being more severe than individuals. Group valuations could more clearly identify the preferences of different community groups. The use of one group's opinion in setting priorities and making guidelines that relate to the public still requires some caution. Policies that do not account for systematic subgroup differences should be made with caution.