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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)

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

Volume (Year): 14 (2005)
Issue (Month): 2 ()
Pages: 197-208
Download reference. The following formats are available: HTML (with abstract), plain text (with abstract), BibTeX, RIS (EndNote, RefMan, ProCite), ReDIF
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 listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. Murray, Christopher J. L. & Acharya, Arnab K., 1997. "Understanding DALYs," Journal of Health Economics, Elsevier, vol. 16(6), pages 703-730, December. [Downloadable!] (restricted)
  2. Fredrik Andersson & Carl Hampus Lyttkens, 1999. "Preferences for equity in health behind a veil of ignorance," Health Economics, John Wiley & Sons, Ltd., vol. 8(5), pages 369-378.
  3. Olsen, Jan Abel, 2000. "A note on eliciting distributive preferences for health," Journal of Health Economics, Elsevier, vol. 19(4), pages 541-550, July. [Downloadable!] (restricted)
  4. Nord, Erik, 1993. "The trade-off between severity of illness and treatment effect in cost-value analysis of health care," Health Policy, Elsevier, vol. 24(3), pages 227-238, August. [Downloadable!] (restricted)
  5. Dolan, Paul & Olsen, Jan Abel, 2001. "Equity in health: the importance of different health streams," Journal of Health Economics, Elsevier, vol. 20(5), pages 823-834, September. [Downloadable!] (restricted)
  6. Jose-Maria Abellan-Perpiñan & Jose-Luis Pinto-Prades, 1999. "Health state after treatment: a reason for discrimination?," Health Economics, John Wiley & Sons, Ltd., vol. 8(8), pages 701-707.
  7. Cookson, Richard & Dolan, Paul, 1999. "Public views on health care rationing: a group discussion study," Health Policy, Elsevier, vol. 49(1-2), pages 63-74, September. [Downloadable!] (restricted)
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  9. Johannesson, Magnus & Gerdtham, Ulf-G, 1996. "A note on the estimation of the equity-efficiency trade-off for QALYs," Journal of Health Economics, Elsevier, vol. 15(3), pages 359-368, June. [Downloadable!] (restricted)
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  11. Cropper, Maureen L & Aydede, Sema K & Portney, Paul R, 1994. "Preferences for Life Saving Programs: How the Public Discounts Time and Age," Journal of Risk and Uncertainty, Springer, vol. 8(3), pages 243-65, May.
  12. Dolan, Paul, 1998. "The measurement of individual utility and social welfare," Journal of Health Economics, Elsevier, vol. 17(1), pages 39-52, January. [Downloadable!] (restricted)
  13. Lindholm, Lars & Rosen, Mans & Emmelin, Maria, 1996. "An epidemiological approach towards measuring the trade-off between equity and efficiency in health policy," Health Policy, Elsevier, vol. 35(3), pages 205-216, March. [Downloadable!] (restricted)
  14. Julie Ratcliffe, 2000. "Public preferences for the allocation of donor liver grafts for transplantation," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 137-148.
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  16. Dolan, Paul & Robinson, Angela, 2001. "The measurement of preferences over the distribution of benefits: The importance of the reference point," European Economic Review, Elsevier, vol. 45(9), pages 1697-1709, October. [Downloadable!] (restricted)
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  19. Culyer, A. J. & Wagstaff, Adam, 1993. "Equity and equality in health and health care," Journal of Health Economics, Elsevier, vol. 12(4), pages 431-457, December. [Downloadable!] (restricted)
  20. Paul Dolan & Colin Green, 1998. "Using the person trade-off approach to examine differences between individual and social values," Health Economics, John Wiley & Sons, Ltd., vol. 7(4), pages 307-312.
  21. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39.
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  23. Eva Rodríguez & José Luis Pinto, 2000. "The social value of health programmes: is age a relevant factor?," Health Economics, John Wiley & Sons, Ltd., vol. 9(7), pages 611-621.
  24. Alan Williams, 1997. "Intergenerational Equity: An Exploration of the 'Fair Innings' Argument," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 117-132.
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  28. Eva Rodríguez-Míguez & José-Luis Pinto-Prades, 2002. "Measuring the social importance of concentration or dispersion of individual health benefits," Health Economics, John Wiley & Sons, Ltd., vol. 11(1), pages 43-53. [Downloadable!]
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Cited by:
(explanations, Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.)

  1. 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. [Downloadable!]
  2. 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. [Downloadable!]
  3. José M. Labeaga & Xisco Oliver & Amedeo Spadaro, . "Measuring Changes in Health Capital," Working Papers 2005-15, FEDEA. [Downloadable!]
  4. Dorte Gyrd-Hansen & Ivar Sønbø 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. [Downloadable!]
  5. 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. [Downloadable!]
  6. Ottar Mæstad & Ole Frithjof Norheim, 2006. "Eliciting People's Preferences for the Distribution of Health: A Procedure for a more Precise Estimation of Distributional Weights," CMI Working Papers WP 2006: 17, CMI (Chr. Michelsen Institute), Bergen, Norway. [Downloadable!]
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