In an era marked by rapid advancements in medical technology and escalating healthcare costs, the ethical and economic valuation of end-of-life treatments remains an intensely debated issue worldwide. A groundbreaking new study led by Cheng, H., Jiang, S., and Liu, T., published in Global Health Research and Policy in 2025, delivers fresh insights into how policymakers in China perceive the value of life-extending interventions for both rare and common diseases. Employing contingent valuation methodology, the research illuminates the complex calculus behind resource allocation in the face of finite healthcare budgets and diverse patient needs.
End-of-life care presents unique challenges due to its profound emotional, ethical, and financial implications. Policymakers must make difficult decisions when prioritizing treatments that often demand substantial resources but yield variable results in patient survival or quality of life improvement. This study’s focus on China is particularly compelling given the country’s vast population, evolving healthcare infrastructure, and the increasing burden of chronic and rare diseases. Such a context offers a rich landscape to explore how decision-makers weigh the benefits and costs of interventions that extend life under terminal or severely debilitating conditions.
The contingent valuation approach utilized by the researchers is pivotal in this investigation. Traditionally employed in environmental economics to estimate willingness to pay for non-market goods, this method adapts well to healthcare by quantifying the monetary value policymakers assign to hypothetical scenarios. Respondents were presented with various detailed treatment profiles and asked to assess the value of funding these interventions, enabling a nuanced understanding of preferences beyond raw cost-effectiveness metrics. This direct elicitation of values from decision-makers in China provides a novel perspective that sidesteps the limitations of purely epidemiological or clinical data.
One of the most striking findings of the study is the differential valuation attached to treatments for rare diseases as compared to common diseases. Despite the rarity of the conditions, some policymakers expressed a willingness to invest heavily in therapies for rare diseases at the end of life, reflecting an emerging ethical stance valuing equity and fairness in healthcare access. This contrasts with the utilitarian calculus typically applied to more common diseases, where the focus tends to revolve around population-level impact and cost-efficiency. The tension between these viewpoints illustrates the evolving norms in health policy, particularly under the pressures of social demand and international human rights discourses.
The research further explores how cultural values influence policymakers’ decisions in China’s unique social and political milieu. Traditional Chinese beliefs around death, filial piety, and collective responsibility play a role in shaping attitudes toward life-extending treatments. For instance, the cultural emphasis on family cohesion and respect for elders may elevate the perceived worth of prolonging life at critical moments. Simultaneously, economic pragmatism and government stewardship of healthcare resources impose constraints that temper such inclinations. This interplay between culture and economics emerges as a central theme in the study’s analysis.
Beyond cultural factors, the study also identifies significant heterogeneity among policymakers based on their professional backgrounds, regional affiliations, and levels of experience. Those working in urban, higher-resource settings tend to value innovative, high-cost treatments more favorably than counterparts in less advantaged provinces. Such disparities highlight the challenges of achieving national equity in healthcare delivery and underscore the importance of transparent and inclusive decision-making frameworks. Policymakers’ varying exposure to clinical evidence and economic analyses contributes to this diversity of perspectives.
The researchers emphasize the implications of their findings for health technology assessment (HTA) processes in China. Current HTA frameworks often prioritize broad population health gains and cost-effectiveness thresholds. However, the study suggests incorporating considerations of disease rarity, patient suffering, and societal values could lead to more ethically robust and socially acceptable prioritization decisions. This could mean adjusting reimbursement guidelines for orphan drugs or approving end-of-life treatments that may not meet conventional cost-effectiveness benchmarks but provide substantial compassionate benefits.
Given China’s colossal healthcare system and the global interest in its policy trajectory, these insights carry significant international ramifications. Other countries grappling with similar issues—balancing innovation, equity, and economic sustainability—can learn from China’s policymaker valuations. The contingent valuation method demonstrated here provides a transferable model for eliciting stakeholder preferences in diverse contexts, complementing quantitative clinical data with qualitative societal values.
The study also raises broader ethical questions surrounding the valuation of life and death in modern medicine. As treatments become more sophisticated and costly, the risk of creating inequities between patients with rare, often genetically defined diseases versus those with widespread chronic conditions intensifies. Policymakers must navigate between maximizing overall health outcomes and ensuring vulnerable populations receive appropriate care. This tension challenges traditional health economics frameworks that prioritize aggregate benefits over individual needs.
Technically, the researchers deployed rigorous statistical models to analyze responses, controlling for sociodemographic and professional variables among policymakers. Their analyses accounted for potential biases inherent to contingent valuation surveys, such as hypothetical bias and strategic misrepresentation, through careful questionnaire design and follow-up interviews. This methodological robustness strengthens confidence in the validity of the derived valuations and the conclusions drawn.
The pioneering nature of this study lies not only in its empirical findings but also in expanding the methodological toolkit available for health policy research. By bringing contingent valuation into the realm of policymaker preferences concerning end-of-life care, new avenues emerge for participatory policymaking and evidence-based priority setting. These innovations align with global trends calling for more transparent, inclusive, and value-sensitive health systems.
From a practical standpoint, the paper encourages Chinese health authorities to reconsider rigid cost-effectiveness thresholds and explore multi-criteria decision analyses that integrate ethical, cultural, and social factors. Such an approach would mirror movements in Western health systems that increasingly recognize the limits of purely quantitative evaluations for complex medical choices with profound human consequences. Embracing this paradigm shift could enhance public trust and policy legitimacy in rapidly modernizing healthcare landscapes.
Moreover, the study’s focus on policymaker perspectives complements existing research centered on patient or public preferences. Incorporating the views of those responsible for resource allocation offers a more comprehensive picture of the health policy ecosystem. It acknowledges that ultimate decisions rest on weighing competing values within institutional constraints rather than solely reflecting clinical evidence or public opinion.
Looking forward, the authors suggest future research avenues including longitudinal studies to observe how policymaker valuations evolve with emerging therapies and shifting social norms. Additionally, extending the approach to incorporate perspectives from frontline clinicians and patient advocacy groups could enrich understanding of consensus and conflict within healthcare decision-making processes. International comparative studies may also reveal cross-cultural patterns influencing end-of-life treatment valuations globally.
In a period when societal debates about medical futility, rationing, and quality of life intensify, studies like this provide critical empirical grounding for nuanced discussions. China’s experience, as captured through this contingent valuation lens, offers a template for grappling with the moral and economic dilemmas posed by modern medicine. It challenges simplistic narratives and encourages multidimensional approaches that respect human dignity while addressing practical realities.
Ultimately, the research underscores that valuing end-of-life treatment is far more than a technical exercise in cost control—it is a reflection of societal priorities, cultural identities, and ethical commitments. Policymakers must balance hope and pragmatism, innovation and equity, compassion and sustainability. The findings presented here contribute vital knowledge to inform these challenging, life-defining choices on a national and international scale.
Subject of Research: Valuation of end-of-life treatments by policymakers for rare and common diseases in China using contingent valuation methodology.
Article Title: How policymakers value end-of-life treatments for rare and common diseases in China: evidence from a contingent valuation study.
Article References:
Cheng, H., Jiang, S., Liu, T. et al. How policymakers value end-of-life treatments for rare and common diseases in China: evidence from a contingent valuation study. glob health res policy 10, 38 (2025). https://doi.org/10.1186/s41256-025-00434-w
Image Credits: AI Generated
