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Théorie de l'utilité et mesure des états de santé, le débat QALYs-HYEs

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  • Claude Le Pen
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    Abstract

    [eng] Utility Theory and Health Status measurement: the Debate QALYs vs HYEs . by Claude Le Pen . A vigorous debate has recently opposed int the field on the economic assessment of medical technologies two methods to value health states : the "Quality Adjusted Life Years" (QALYs) and the "Healthy Years Equivalents" (HYEs). For a given health state, the QALYs are defined as the sum of life years allowed in a définie health state, each year being weighted by a coefficient, which reflects the utility of is "quality". The coefficient value varies between 0 and 1, 0 being attached to the worse quality and 1 to the best. This indicator, whose simplicity and intuitive appeal certainly explain the great success, faces nevertheless serious theoretical probems. It can be shown in fact that the preference pattern of an agent who would prefer health state A to health state B if and only if the number of QALYs in A is grater than that in B, obeys a set of restrictive assumptions, so that the psychological profile of the agent lacks credibility. Some authors have thus proposed an alternate measurement, the HYEs, which have the advantage to give an integrated utility measure of both quality and quantity of life, without requiring a complete and restrictive specification of the utility function. More general from a theoretical point of view, this concept proves impossible to be practically implemented. The methods designef to compute empirically the HYEs implicitly require in fact the same limitung assumptions than the QALYs. So, we have from one hand a concept which is easy to implement empirically but without a great theoretical relevance and, from the other hand, a concept which is richer at the theoretical level but is disappointing at the pratical level. Apart from the technical matters, the debate has the interest to reveal the meaning and the limit of the application of utility theory to the measurement of health state. [fre] Théorie de l'utilité et mesure des états de santé, le débat QALYs-HYEs . par Claude Le Pen . i de la théorie de l'évaluation économique, deux méthodes de valorisation des états les "Healthy Years Equivalent" (HYEs). Pour un état de santé donné, les QALYs se définissent comme la somme des années de vie offerte dans ces états de santé, chacune étant pondérée par un coefficient, compris entre 0 et 1 , reflétant l'utilité de sa "qualité". La valeur 0 est affecté à la pire qualité ; 1 à la meilleure. Cet indicateur, dont la simplicité et le caractère intuitif a assuré le succès, pose néanmoins un sérieux problème théorique. Il est en effet possible de montrer que les préférences d'un agent qui choisirait systématiquement l'état A et l'état B si et seulement si le nombre de QALYs de A est supérieur à ceui de B, doivent être soumises à des hypothèses telles que la vraisemblance d'un tel profil psychologique est douteuse. Certains auteurs ont proposé une mesure alternative, les HYEs, qui ont l'avantage de donner une mesure intégrée des préférences sur le couple qualité-quantité de vie et de ne pas nécessiter de spécification précise de la fonction d'utilité. Plus général sur un plan théorique, ce concept s'avère en pratique impossible à utiliser. Les méthodes imaginées par ces promoteurs s'avèrent en effet nécessiter les mêmes hypothèses que celles des QALYs. Ainsi, dispose-t-on à la fois d'un concept facile à mesurer mais sans grande portée théorique et d'un concept plus riche théoriquement, mais décevant en pratique. Au-delà des aspects techniques, ce débat a ainsi l'intérêt de révéler la portée et les limites du recours à la théorie économique pour représenter les états de santé.

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    Bibliographic Info

    Article provided by Programme National Persée in its journal Économie & prévision.

    Volume (Year): 129 (1997)
    Issue (Month): 3 ()
    Pages: 37-54

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    Handle: RePEc:prs:ecoprv:ecop_0249-4744_1997_num_129_3_5863

    Note: DOI:10.3406/ecop.1997.5863
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    Web page: http://www.persee.fr/web/revues/home/prescript/revue/ecop

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    1. Johannesson, Magnus, 1995. "Quality-adjusted life-years versus healthy-years equivalents -- A comment," Journal of Health Economics, Elsevier, Elsevier, vol. 14(1), pages 9-16, May.
    2. Tony J Culyer & Adam Wagstaff, 1992. "QALYs versus HYEs - a theoretical exposition," Working Papers, Centre for Health Economics, University of York 099chedp, Centre for Health Economics, University of York.
    3. James S. Dyer & Rakesh K. Sarin, 1982. "Relative Risk Aversion," Management Science, INFORMS, INFORMS, vol. 28(8), pages 875-886, August.
    4. Peter H. Farquhar, 1984. "State of the Art---Utility Assessment Methods," Management Science, INFORMS, INFORMS, vol. 30(11), pages 1283-1300, November.
    5. Loomes, Graham, 1995. "The myth of the HYE," Journal of Health Economics, Elsevier, Elsevier, vol. 14(1), pages 1-7, May.
    6. Mehrez, Abraham & Gafni, Amiram, 1987. "An empirical evaluation of two assessment methods for utility measurement for life years," Socio-Economic Planning Sciences, Elsevier, Elsevier, vol. 21(6), pages 371-375.
    7. Johannesson, Magnus & Johansson, Per-Olov & Kristrom, Bengt & Gerdtham, Ulf-G., 1993. "Willingness to pay for antihypertensive therapy -- further results," Journal of Health Economics, Elsevier, Elsevier, vol. 12(1), pages 95-108, April.
    8. Gafni, Amiram & Birch, Stephen & Mehrez, Abraham, 1993. "Economics, health and health economics: HYEs versus QALYs," Journal of Health Economics, Elsevier, Elsevier, vol. 12(3), pages 325-339, October.
    9. Loomes, Graham & McKenzie, Lynda, 1989. "The use of QALYs in health care decision making," Social Science & Medicine, Elsevier, Elsevier, vol. 28(4), pages 299-308, January.
    10. A Mehrez & A Gafni, 1991. "Healthy Years Equivalent: How to Measure Them Using the Standard Gamble Approach," Centre for Health Economics and Policy Analysis Working Paper Series, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada 22, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    11. D Feeny & G Torrance, 1989. "Incorporating Utility-based Quality-of-life Assessment Measures in Clinical Trials: Two Examples," Centre for Health Economics and Policy Analysis Working Paper Series, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada 12, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    12. Claire Gudex & Paul Kind & Harmanna van Dalen & Mary-Alison Durand & Jenny Morris & Alan Williams, 1993. "Comparing scaling methods for health state valuations - Rosser revisited," Working Papers, Centre for Health Economics, University of York 107chedp, Centre for Health Economics, University of York.
    13. Buckingham, Ken, 1993. "A note on HYE (healthy years equivalent)," Journal of Health Economics, Elsevier, Elsevier, vol. 12(3), pages 301-309, October.
    14. Bleichrodt, Han, 1995. "QALYs and HYEs: Under what conditions are they equivalent?," Journal of Health Economics, Elsevier, Elsevier, vol. 14(1), pages 17-37, May.
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