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QALY maximisation and people's preferences: a methodological review of the literature

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Author Info

  • Paul Dolan
  • Rebecca Shaw

    (Department of Sociology, University of York, UK)

  • Aki Tsuchiya

    (Sheffield Health Economics Group, University of Sheffield, UK)

  • Alan Williams

    (Centre for Health Economics, University of York, UK)

Abstract

In cost-utility analysis, the numbers of quality-adjusted life years (QALYs) gained are aggregated according to the sum-ranking (or QALY maximisation) rule. This requires that the social value from health improvements is a simple product of gains in quality of life, length of life and the number of persons treated. The results from a systematic review of the literature suggest that QALY maximisation is descriptively flawed. Rather than being linear in quality and length of life, it would seem that social value diminishes in marginal increments of both. And rather than being neutral to the characteristics of people other than their propensity to generate QALYs, the social value of a health improvement seems to be higher if the person has worse lifetime health prospects and higher if that person has dependents. In addition, there is a desire to reduce inequalities in health. However, there are some uncertainties surrounding the results, particularly in relation to what might be affecting the responses, and there is the need for more studies of the general public that attempt to highlight the relative importance of various key factors. Copyright © 2004 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.924
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Bibliographic Info

Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 14 (2005)
Issue (Month): 2 ()
Pages: 197-208

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Handle: RePEc:wly:hlthec:v:14:y:2005:i:2:p:197-208

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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References

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Citations

Blog mentions

As found by EconAcademics.org, the blog aggregator for Economics research:
  1. Recommended reading for Steven Levitt
    by Chris Sampson in The Academic Health Economists' Blog on 2014-05-22 16:59:41
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  1. Dana Goldman & Darius Lakdawalla & Tomas J. Philipson & Wesley Yin, 2010. "Valuing health technologies at nice: recommendations for improved incorporation of treatment value in HTA," Health Economics, John Wiley & Sons, Ltd., vol. 19(10), pages 1109-1116.
  2. Colin Green & Karen Gerard, 2009. "Exploring the social value of health-care interventions: a stated preference discrete choice experiment," Health Economics, John Wiley & Sons, Ltd., vol. 18(8), pages 951-976.
  3. Shah, Koonal K., 2009. "Severity of illness and priority setting in healthcare: A review of the literature," Health Policy, Elsevier, vol. 93(2-3), pages 77-84, December.
  4. Weale, Martin, 2011. "A cost-benefit analysis of cataract surgery based on the English Longitudinal Survey of Ageing," Journal of Health Economics, Elsevier, vol. 30(4), pages 730-739, July.
  5. Nord, Erik & Johansen, Rune, 2014. "Concerns for severity in priority setting in health care: A review of trade-off data in preference studies and implications for societal willingness to pay for a QALY," Health Policy, Elsevier, vol. 116(2), pages 281-288.
  6. Dorte Gyrd-Hansen & Ivar S�nb� Kristiansen, 2008. "Preferences for 'life-saving' programmes: Small for all or gambling for the prize?," Health Economics, John Wiley & Sons, Ltd., vol. 17(6), pages 709-720.
  7. José M. Labeaga & Xisco Oliver & Amedeo Spadaro, . "Measuring Changes in Health Capital," Working Papers 2005-15, FEDEA.
  8. David Epstein & Dolores Jiménez-Rubio & Peter C. Smith & Marc Suhrcke, 2009. "Social determinants of health: an economic perspective," Health Economics, John Wiley & Sons, Ltd., vol. 18(5), pages 495-502.
  9. Richardson, Jeff & Sinha, Kompal & Iezzi, Angelo & Maxwell, Aimee, 2012. "Maximising health versus sharing: Measuring preferences for the allocation of the health budget," Social Science & Medicine, Elsevier, vol. 75(8), pages 1351-1361.
  10. Gill, Betty & Griffin, Barbara & Hesketh, Beryl, 2013. "Changing expectations concerning life-extending treatment: The relevance of opportunity cost," Social Science & Medicine, Elsevier, vol. 85(C), pages 66-73.
  11. Promberger, Marianne & Dolan, Paul & Marteau, Theresa M., 2012. "“Pay them if it works”: Discrete choice experiments on the acceptability of financial incentives to change health related behaviour," Social Science & Medicine, Elsevier, vol. 75(12), pages 2509-2514.
  12. Nord, Erik, 2012. "Measuring concerns for severity: Re-examination of a health scale with purported equal interval properties," Health Policy, Elsevier, vol. 105(2), pages 312-316.
  13. Richard Norman & Gisselle Gallego, 2008. "Equity weights for economic evaluation: An Australian Discrete Choice Experiment, CHERE Working Paper 2008/5," Working Papers 2008/5, CHERE, University of Technology, Sydney.
  14. Tappenden, P & Brazier, J & Ratcliffe, J, 2006. "Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A," MPRA Paper 29772, University Library of Munich, Germany.
  15. Johansson-Stenman, Olof & Martinsson, Peter, 2008. "Are some lives more valuable? An ethical preferences approach," Journal of Health Economics, Elsevier, vol. 27(3), pages 739-752, May.
  16. Hurley, Jeremiah & Mentzakis, Emmanouil, 2013. "Health-related externalities: Evidence from a choice experiment," Journal of Health Economics, Elsevier, vol. 32(4), pages 671-681.
  17. Mortimer, Duncan & Peacock, Stuart, 2012. "Social welfare and the Affordable Care Act: Is it ever optimal to set aside comparative cost?," Social Science & Medicine, Elsevier, vol. 75(7), pages 1156-1162.
  18. Werner B. F. Brouwer & Frans F. H. Rutten, 2010. "The efficiency frontier approach to economic evaluation: will it help German policy making?," Health Economics, John Wiley & Sons, Ltd., vol. 19(10), pages 1128-1131.
  19. Friedrich Breyer, 2009. "Health Care Rationing and Distributive Justice," Rationality, Markets and Morals, Frankfurt School Verlag, Frankfurt School of Finance & Management, vol. 0(27), November.
  20. Anthony J Culyer & Yvonne Bombard, 2011. "An Equity Checklist: a Framework for Health Technology Assessments," Working Papers 062cherp, Centre for Health Economics, University of York.
  21. Leonie Segal & Kim Dalziel & Duncan Mortimer, 2010. "Fixing the game: are between-silo differences in funding arrangements handicapping some interventions and giving others a head-start?," Health Economics, John Wiley & Sons, Ltd., vol. 19(4), pages 449-465.
  22. Ottersen, Trygve & Mbilinyi, Deogratius & Maestad, Ottar & Norheim, Ole Frithjof, 2008. "Distribution matters: Equity considerations among health planners in Tanzania," Health Policy, Elsevier, vol. 85(2), pages 218-227, February.
  23. Richardson, Jeff & McKie, John, 2007. "Economic evaluation of services for a National Health Scheme: The case for a fairness-based framework," Journal of Health Economics, Elsevier, vol. 26(4), pages 785-799, July.
  24. Lancsar, Emily & Wildman, John & Donaldson, Cam & Ryan, Mandy & Baker, Rachel, 2011. "Deriving distributional weights for QALYs through discrete choice experiments," Journal of Health Economics, Elsevier, vol. 30(2), pages 466-478, March.
  25. Mæstad, Ottar & Norheim, Ole Frithjof, 2012. "A universal preference for equality in health? Reasons to reconsider properties of applied social welfare functions," Social Science & Medicine, Elsevier, vol. 75(10), pages 1836-1843.

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