Nermina Ferizovic | Health Economics Expert

Despite lack of an accepted definition for the ‘value of hope’, the concept is regularly utilised as part of discussions on the value of health interventions, particularly advanced therapies as evidenced by a recent documentary analysis¹. 

Value of hope is a subjective concept used to portray the belief that treatment could prove beneficial to patients. A proposed definition is “a patients’ potential preferences for a wider distribution of treatment benefit with a positive skew”² – in other words, it represents a patient’s preference for the chance to achieve a positive clinical benefit. As a concept, value of hope has an obvious intangible psychological element to it which implicitly means that the quantification of ‘hope’ would be difficult. Despite this, there are two recent examples where researchers have tried to quantify ‘hope’ using preference studies^3,4. 

The first of these is a discrete choice experiment from the US where the researchers included the probability of 10-year survival, expected survival, health status and out-of-pocket costs as attributes. The authors determined that cancer patients “negatively valued a 20% chance of 10-year survival that required an offsetting 80% chance of shorter survival” with a linear trend between survival and monetary value. These findings are used to support the idea of value of hope as “independent of expected survival and health status”. In other words, the study shows that preferences of individuals with cancer are for treatment alternatives that offer them a higher probability of 10-year survival (we will leave discussions of the feasibility of a 20% chance of 10-year survival with only an 80% chance of short-term survival) and that individuals were willing to pay more for higher survival gains. The second study is a replication of the first but with the added element of comparing cancer patient preferences with those of the general public in South Korea. The findings of the two studies were similar. 

A couple of points about these studies should be highlighted. The authors have implicitly argued that ‘value of hope’ is a quantifiable value attribute in its own right despite it being a combination of clinical benefit and risk preferences, the latter being very individual and thus difficult to argue as a value attribute. Certainly, the authors have identified that preferences for clinical benefits are linked to an individual’s risk preference. Were we to disregard the second point, attempts to quantify a concept which is at its core intangible is undoubtedly questionable. The difficulties associated with quantifying an unquantifiable concept raise questions regarding its inclusion in value assessment frameworks. 

Regarding the inclusion of ‘value of hope’ in a value assessment framework for advanced therapies, there are several considerations. Firstly, the significant overlap between (pre-existing) value attributes (i.e., clinical benefits) means it is difficult to argue for the inclusion of ‘value of hope’ as a separate concept in value assessment frameworks as there is no demarcation between ‘value of hope’ and ‘clinical benefits’. Value attributes should be independent of each other for them to usefully inform Health Technology Assessment. Where it is arguably impossible to quantify a value attribute, there would be no valuable contribution to value assessments of advanced therapies. It also needs to be said that the individuality of risk preferences excludes the possibility of this being a separate value attribute. All in all, ‘value of hope’ can be considered a special case of clinical benefits which accounts for an individual’s risk preferences. 

1. Ferizović et al. 2025. Value attributes of advanced therapy medicinal products: a documentary analysis of comments received from stakeholders during reimbursement decisions to England’s National Institute of Health and Care Excellence; Expert Rev Pharmacoecon Outcomes Res; 25(4):605-621
2. Lakdawalla et al. 2018. Defining elements of value in health care—a health economics approach: an ISPOR special task force report [3]; Value Health; 21:131-139
3. Reed et al. 2021. Quantifying value of hope; Value Health. 2021; 24:1511-1519
4. Hong et al. 2025. The Value of Hope in Cancer Care: Risk Preference and Heterogeneity in Cancer Patients and the General Public; Value Health; in press