Previous evidence suggests that members of the public value life saving services differently when they are for patients with a pre-existing permanent disability and when they are for patients who become disabled at the onset of treatment – for example, as a result of treatment that is not entirely effective. However, the valuation of services in these two cases has also been found to differ with the order in which they are presented in a population survey. This casts doubt upon the validity of the results and leaves unresolved the nature of the public’s true preferences. The study reported here had three main objectives: (i) to determine the considered, underlying preferences of a sample of the Australian public with respect to the treatment of the permanently disabled and chronically ill, (ii) to gain insight into the reasons for respondent’s distributive preferences and (iii) to eliminate or significantly reduce the order effect. Eight semi-structured, small-group discussions were held with 66 members of the public in Victoria, Australia. Order effects were effectively eliminated. The study found substantial support among participants for the equal treatment of the permanently disabled and chronically ill regardless of when the problem commenced.

The inclusion of both monetary and non-monetary indirect benefits in economic evaluations of public health programmes and services can have significant distributive effects between patient groups. As a result, some patients may be advantaged and others disadvantaged for reasons not directly related to health outcomes or (direct) treatment costs. In pluralistic democracies, there is a case for consulting the community on the fairness of policies that have such distributive implications. This paper reports the results of two pilot studies aimed at uncovering the preferences of the Australian public for the inclusion of indirect benefits in the evaluation of services for its national health scheme, Medicare. The initial survey found some support for taking account of non-monetary indirect benefits – for example, the social contribution made by parents of young children and carers of elderly relatives. By contrast, there was little support for giving high taxpayers priority access to general Medicare services, to life-saving organ transplants, or to very costly drugs, despite the indirect social benefits of doing so. However, such support increased significantly in the follow-up study when the outcomes were characterised as certain, identifiable and health related, and the opportunity costs of failing to take account of indirect benefits were made very clear. The follow-up survey provided evidence of public scepticism about the willingness or ability of government to use additional tax receipts for socially beneficial purposes, and/or a preference for programmes and services that focus on health rather than welfare more generally.

What proportion of available healthcare funds should be allocated to hip replacement operations and what proportion to psychiatric care? What proportion should go to cardiac patients and what to newborns in intensive care? What proportion should go to preventative medicine and what to treating existing conditions? In general, how should limited healthcare resources (people, facilities, equipment, drugs…) be distributed If not all demands can be met?

In most of the cost-utility literature, quality-adjusted life-year (QALY) gains are interpreted as a measure of social value. Given this interpretation, the validity of different multi-attribute health-state scaling instruments may be tested by comparing the values they provide on the 0–1 QALY scale with directly elicited preferences for person trade-offs between different treatments (equivalence of numbers of different patients treated). Norwegian and Australian public preferences as measured by the person trade-off suggest that the EuroQol Instrument assigns excessively low values to health states. This seems to be even more true of the McMaster Health Classification System. The Quality of Well-being Scale appears to compress states toward the middle of the 0–1 scale. By contrast, the Rosser/Kind index fits reasonably well with directly measured person trade-off data.

Objective: To examine the potential impact of elderly age on response to participation in a structured, multidisciplinary quality-of-life (QOL) intervention for patients with advanced cancer undergoing radiation therapy.

Methods: Study design was a randomized stratified, two group, controlled clinical trial in the setting of a tertiary care comprehensive cancer center. Subjects with newly diagnosed cancer and an estimated 5-year survival rate of 0%–50% who required radiation therapy were recruited and randomly assigned to either an intervention group or a standard care group. The intervention consisted of eight 90-min sessions designed to address the five QOL domains of cognitive, physical, emotional, spiritual, and social functioning. QOL was measured using Spitzer uniscale and linear analogue self-assessment (LASA) at baseline and weeks 4, 8, and 27.

Results: Of the 103 study participants, 33 were geriatric (65 years or older), of which 16 (mean age 72.4 years) received the intervention and 17 (mean age 71.4 years) were assigned to the standard medical care. The geriatric participants who completed the intervention had higher QOL scores at baseline, at week 4 and at week 8, compared to the control participants.

Significance of results: Our results demonstrate that geriatric patients with advanced cancer undergoing radiation therapy will benefit from participation in a structured multidisciplinary QOL intervention. Therefore, geriatric individuals should not be excluded from participating in a cancer QOL intervention, and, in fact, elderly age may be an indicator of strong response to a QOL intervention. Future research should further explore this finding.

Enhancing the polyunsaturated fatty acid (PUFA) and decreasing the saturated fatty acid content of beef is an important target in terms of improving the nutritional value of this food for the consumer. The present study examined the effects of feeding a ruminally protected lipid supplement (PLS) rich in PUFA on the fatty acid composition of longissimus thoracis muscle and associated subcutaneous adipose tissue. Animals were fed ad libitum on grass silage plus one of three concentrate treatments in which the lipid source was either Megalac (rich in palmitic acid; 16:0) or PLS (soyabean, linseed and sunflower-seed oils resulting in an 18:2n−6:18:3n−3 value of 2·4:1). Treatment 1 contained 100g Megalac/kg (Mega, control); treatment 2 (PLS1) contained 54g Megalac/kg with 500g PLS/d fed separately; treatment 3 (PLS2) contained no Megalac and 1000g PLS/d fed separately. The PLS was considered as part of the overall concentrate allocation per d in maintaining an overall forage:concentrate value of 60:40 on a DM basis. Total dietary fat was formulated to be 0·07 of DM of which 0·04 was the test oil. Total intramuscular fatty acids (mg/100g muscle) were decreased by 0·31 when feeding PLS2 compared with Mega (P<0·05). In neutral lipid, the PLS increased the proportion of 18:2n−6 and 18:3n−3 by 2·7 and 4·1 on diets PLS1 and PLS2 v. Mega, respectively. Similar responses were noted for these fatty acids in phospholipid. The amounts or proportions of 20:4n−6, 20:5n−3 or 22:6n−3 were not influenced by diet whereas the amounts and proportions of 22:4n−6 and 22:5n−3 in phospholipid were decreased with inclusion of the PLS. The amounts of the saturated fatty acids, 14:0, 16:0 and 18:0, in neutral lipid were on average 0·37 lower on treatment PLS2 compared with Mega. Feeding the PLS also decreased the proportion of 16:0 in neutral lipid. The amount of 18:1n-9 (P=0·1) and the amount and proportion of 18:1 trans (P<0·01) were lower on treatments PLS1 and PLS2 in neutral lipid and phospholipid. Conjugated linoleic acid (cis-9, trans-11) was not influenced by diet in the major storage fraction for this fatty acid, neutral lipid. The PUFA:saturated fatty acids value was increased markedly (×2·5) with inclusion of the PLS (P<0·001) while the σn−6:n−3 value increased slightly (×1·2; P=0·015). The results suggest that the protected lipid used, which was rich in PUFA, had a high degree of protection from the hydrogenating action of rumen micro-organisms. The PLS resulted in meat with a lower content of total fat, decreased saturated fatty acids and much higher 18:2n−6 and 18:3n−3. The net result was a large shift in polyunsaturated: saturated fatty acids, 0·28 v. 0·08, on feeding PLS2 compared with Mega, respectively.

Objectives: Decision-makers and the general public are often reluctant to adopt policy recommendations based exclusively upon cost–utility analyses. One possible reason explored here is that patients' previous health state before experiencing the onset of an acute life-threatening illness may influence the value of saving those patients' lives.

Methods: We surveyed members of the general public to see the relative importance of saving patients' lives when some patients could be returned to perfect health and others would live the remainder of their years with paraplegia. Among this latter group, some were described as having pre-existing paraplegia. Others were described as having the onset of paraplegia. The relative importance of saving each of these lives was measured using the person trade-off method.

Results: Six hundred five subjects completed questionnaires, and 250 met pre-established consistency criteria and were included in the final analysis. Overall, subjects placed equal importance on saving the lives of people with pre-existing paraplegia versus those who could be returned to perfect health because they did not have pre-existing paraplegia. In contrast, respondents gave lower priority to patients who would experience the onset of paraplegia after having their lives saved, especially if their paraplegia was avoidable with an alternative treatment.

Conclusion: People do not think that all quality-adjusted life-years are created equal. Instead, the value that people place on treatment programs depends on patients' state of health before developing life-threatening illnesses, and on whether alternative treatments are available that provide better health outcomes for the patients. These results may explain, in part, public discomfort over basing health care priorities on cost–utility analysis.