Financials constraints of health systems require suitable indices and criteria to better
allocate resources in order to enhance and maximize social welfare. Among multiple methods,
the quality-adjusted life year (QALY) is used as a validated and preference-base measure for
health care procedures in health economics studies such as cost-utility analyses.
In France, the methodological guide of the public agency of the High Authority for Health
(HAS) recommends the valuation of health states with the use of a generic and descriptive
instrument (EQ5D), validated by the Time Trade Off method (TTO) in samples from general
Although it appears to be legitimate to distribute collective resources based on general
population preferences, a major concern is that individuals do not face a real choice that
can have a direct implication on their welfare and their life.
The existence of a discrepancy between revealed "hypothetical" preferences and real
preferences would raise the problem concerning production of the currently available
standards and norms. Hence, a methodological deepening of these preferences revelation
process is necessary.
Virtual reality (VR) could play a key role in resolving this methodological problem. Widely
used in the field of health (such as therapy, medical training...), VR is a simulation that
seeks to approach the reality, without trying to be quite like it. It aims one or more
individuals to explore a sensorimotor and cognitive activity in an artificial world in 3D,
which can be "imaginary, symbolic or a simulation of some aspects of the real world" (Fuchs,
2006). VR could be well applied to the field of health economics by offering hypothetical
scenarios of the different health states from the EQ5D that individuals might experience in
the first person.
To date, existence of this discrepancy between revealed "hypothetical" preferences and actual
preferences of individuals from the general population is extremely difficult to explore.
However, this is an important methodological challenge in the revelation of preferences to
guide health-related decisions.
Indeed, comparing the revealed preferences about health states established from a first
person experience in VR to the revealed preferences established from the classic narrative
approach without VR, may provide an accurate approach of actual and real preferences of
individuals from the general population.
Moreover, another advantage of VR is to permit the assessment of a greater number of health
states, this method being faster processed than the narrative approach: individuals are
experimenting immediate experience of a situation when under VR. Thus, VR method may overcome
technical constraints of the classic narrative approach concerning limited sample sizes in
To the investigators knowledge, VR has never been proposed for valuating health conditions.
This study would report the relevance and interest in using VR (immersive and immediate life
situation experience) for the production of utility EQ5D health states values in the general
population by the revelation of preferences method called the Time Trade Off (TTO), the
currently approach recommended by the HAS.
Using VR could circumvent some limitations of the current narrative approach: it would
provide a better feasibility and acceptability among subjects, fewer inconsistencies, an
easier and wider access to disadvantaged individuals. Eventually revisions of available
standards could be proposed to allow the HAS and policy makers to base their choices on more
reliable, standardized and accurate classifications of health states conditions, that
associate each health state to a predefined value.