Death stepped out on the street

Abstract

The main purpose of this paper is to demonstrate the evidence that already exists in the Portuguese context of evaluation of health states worse than death. The aim is to also make a personal reflection on the current state of the literature on the measurement of these health states and list some existing problems of methodological nature. This type of health states, in fact, exist and it is known and understood by patients and by the general population. Several are the techniques used to determine the cardinal preferences for health states worse than death and its use is usual in cost‑effectiveness or cost‑utility assessments. However, the measurement of preferences for health states worse than death is still at an early stage of development, keeping the need of elicitation techniques probably more valid and reliable. It is essential to deepen the discussion on the concept of health states worse than death.