Should Productivity Loss Be Explicit in Willingness to Pay (WTP) and QALY Costs?
This section neither endorses nor disavows the use of WTP, a choice on which the authors are divided. We agree that explicit work loss estimates are informative and valuable regardless of the cost framework used. People want to know about work losses and related tax losses, but including them with QALYs or WTP estimates poses the risk of double counting. A WTP value of life or a QALY estimate inherently includes all sources of value from the life process. Therefore, its use with a separate wage loss estimate implies that wage loss has been double counted. However, using only WTP or QALY estimates of injury burden means that persons uncomfortable with using WTP measures or QALYs will be unable to salvage cost estimates from the burden estimates. One approach which Arthur (1980) and Miller, Calhoun, and Arthur (1989) claim is appropriate is to subtract the work loss from the WTP estimate and show it as a separate cost component. This allows analysts who use a WTP cost framework to provid
