Is a QALY still a QALY at the end of life?
AbstractRecent research into end of life and palliative care has focused on the development of a replacement for the quality adjusted life year (QALY) as an outcome measure. Reasons given range from the lack of anticipated survival benefit from treatment to the inappropriateness of death as an anchor for valuing health states, or the increased value of time to the individual at the end of life. The Palliative Care Yardstick, has been proposed as an alternative. In this paper, I argue that the QALY should not be abandoned as an outcome measure in end of life and palliative care populations and suggest possible methods for generating empirical data to support or refute this. I show why the arguments made for replacement of the QALY are not supported by current evidence and how in some cases the abandonment of the QALY framework would lead to an unjustifiable inequitable distribution of resources.
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Bibliographic InfoArticle provided by Elsevier in its journal Journal of Health Economics.
Volume (Year): 31 (2012)
Issue (Month): 3 ()
Contact details of provider:
Web page: http://www.elsevier.com/locate/inca/505560
Quality of life; Palliative care; End of life care; Ethics; Resource allocation;
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- Aki Tsuchiya & Richard Edlin & Paul Dolan, 2009. "Measuring the societal value of lifetime health," Working Papers 2009010, The University of Sheffield, Department of Economics, revised May 2009.
- Dolan, Paul & Stalmeier, Peep, 2003. "The validity of time trade-off values in calculating QALYs: constant proportional time trade-off versus the proportional heuristic," Journal of Health Economics, Elsevier, vol. 22(3), pages 445-458, May.
- Mike Paulden & Anthony J. Culyer, 2010. "Does Cost-Effectiveness Analysis Discriminate against Patients with Short Life Expectancy?," Working Paper Series 41_10, The Rimini Centre for Economic Analysis.
- Karl Claxton & Mike Paulden & Hugh Gravelle & Werner Brouwer & Anthony J. Culyer, 2011. "Discounting and decision making in the economic evaluation of health‐care technologies," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 2-15, January.
- Devlin, N. & Tsuchiya, A. & Buckingham, K. & Tilling, C., 2009.
"A uniform Time Trade Off method for states better and worse than dead: feasibility study of the ‘lead time’ approach,"
09/08, Department of Economics, City University London.
- Nancy J. Devlin & Aki Tsuchiya & Ken Buckingham & Carl Tilling, 2011. "A uniform time trade off method for states better and worse than dead: feasibility study of the ‘lead time’ approach," Health Economics, John Wiley & Sons, Ltd., vol. 20(3), pages 348-361, March.
- Ryan, Mandy & Netten, Ann & Skatun, Diane & Smith, Paul, 2006. "Using discrete choice experiments to estimate a preference-based measure of outcome--An application to social care for older people," Journal of Health Economics, Elsevier, vol. 25(5), pages 927-944, September.
- Allan Wailoo & Aki Tsuchiya & Christopher McCabe, 2009. "Weighting Must Wait: Incorporating Equity Concerns into Cost-Effectiveness Analysis May Take Longer than Expected," PharmacoEconomics, Springer Healthcare | Adis, vol. 27(12), pages 983-989.
- Coast, Joanna & Smith, Richard D. & Lorgelly, Paula, 2008. "Welfarism, extra-welfarism and capability: The spread of ideas in health economics," Social Science & Medicine, Elsevier, vol. 67(7), pages 1190-1198, October.
- Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
- Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
- Brouwer, Werner B.F. & Culyer, Anthony J. & van Exel, N. Job A. & Rutten, Frans F.H., 2008. "Welfarism vs. extra-welfarism," Journal of Health Economics, Elsevier, vol. 27(2), pages 325-338, March.
- Katherine Stevens, 2011. "Assessing the performance of a new generic measure of health-related quality of life for children and refining it for use in health state valuation," Applied Health Economics and Health Policy, Springer, vol. 9(3), pages 157-169, May.
- Samer A. Kharroubi & Anthony O'Hagan & John E. Brazier, 2005. "Estimating utilities from individual health preference data: a nonparametric Bayesian method," Journal of the Royal Statistical Society Series C, Royal Statistical Society, vol. 54(5), pages 879-895.
- Potoglou, Dimitris & Burge, Peter & Flynn, Terry & Netten, Ann & Malley, Juliette & Forder, Julien & Brazier, John E., 2011. "Best-worst scaling vs. discrete choice experiments: An empirical comparison using social care data," Social Science & Medicine, Elsevier, vol. 72(10), pages 1717-1727, May.
- Moore, Michael J. & Viscusi, W. Kip, 1990. "Discounting environmental health risks: New evidence and policy implications," Journal of Environmental Economics and Management, Elsevier, vol. 18(2), pages S51-S62, March.
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