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QALYs, DALYs, and HALYs: a unifying framework for the evaluation of population health

Author

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  • Juan D. Moreno-Ternero

    (Department of Economics, Universidad Pablo de Olavide)

  • Trine T. Platz

    (Department of Food and Resource Economics, University of Copenhagen)

  • Lars P. Østerdal

    (Department of Economics, Copenhagen Business School)

Abstract

We provide a unifying framework for the evaluation of population health. We formalize several axioms for social preferences over distributions of health. We show that a specific combination of those axioms characterizes a large class of population health evaluation functions combining concerns for quality of life, quantity of life and health shortfalls. We refer to the class as (unweighted) aggregations of health-adjusted life years (HALYs). Two focal (and polar) members of this family are the (unweighted) aggregations of quality-adjusted life years (QALYs), and of disability-adjusted life years (DALYs). We also provide new characterization results for these focal members that enable us to scrutinize their normative foundations and shed new light on their similarities and differences.

Suggested Citation

  • Juan D. Moreno-Ternero & Trine T. Platz & Lars P. Østerdal, 2023. "QALYs, DALYs, and HALYs: a unifying framework for the evaluation of population health," Working Papers 23.01, Universidad Pablo de Olavide, Department of Economics.
    • Handle: RePEc:pab:wpaper:23.01
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    1. Abram Burk, 1936. "Real Income, Expenditure Proportionality, and Frisch's "New Methods of Measuring Marginal Utility"," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 4(1), pages 33-52.
    2. Blackorby,Charles & Bossert,Walter & Donaldson,David J., 2005. "Population Issues in Social Choice Theory, Welfare Economics, and Ethics," Cambridge Books, Cambridge University Press, number 9780521532587.
    3. Hougaard, Jens Leth & Moreno-Ternero, Juan D. & Østerdal, Lars Peter, 2012. "A unifying framework for the problem of adjudicating conflicting claims," Journal of Mathematical Economics, Elsevier, vol. 48(2), pages 107-114.
    4. Gustavo Bergantiños & Juan D. Moreno-Ternero, 2022. "On the axiomatic approach to sharing the revenues from broadcasting sports leagues," Social Choice and Welfare, Springer;The Society for Social Choice and Welfare, vol. 58(2), pages 321-347, February.
    5. Juan D. Moreno-Ternero & Lars Peter Østerdal, 2017. "A normative foundation for equity-sensitive health evaluation: The role of relative comparisons of health gains," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 19(5), pages 1009-1025, October.
    6. Andrew Briggs & Anna Vassall, 2021. "Count the cost of disability caused by COVID-19," Nature, Nature, vol. 593(7860), pages 502-505, May.
    7. Esteban, Joan & Ray, Debraj, 1994. "On the Measurement of Polarization," Econometrica, Econometric Society, vol. 62(4), pages 819-851, July.
    8. Blackorby, Charles & Bossert, Walter & Donaldson, David, 1997. "Birth-Date Dependent Population Ethics: Critical-Level Principles," Journal of Economic Theory, Elsevier, vol. 77(2), pages 260-284, December.
    9. Mara Airoldi & Alec Morton, 2009. "Adjusting life for quality or disability: stylistic difference or substantial dispute?," Health Economics, John Wiley & Sons, Ltd., vol. 18(11), pages 1237-1247, November.
    10. Osterdal, Lars Peter, 2005. "Axioms for health care resource allocation," Journal of Health Economics, Elsevier, vol. 24(4), pages 679-702, July.
    11. Wagstaff, Adam, 1991. "QALYs and the equity-efficiency trade-off," Journal of Health Economics, Elsevier, vol. 10(1), pages 21-41, May.
    12. Hougaard, Jens Leth & Moreno-Ternero, Juan D. & Østerdal, Lars Peter, 2013. "A new axiomatic approach to the evaluation of population health," Journal of Health Economics, Elsevier, vol. 32(3), pages 515-523.
    13. Alan Williams, 1997. "Intergenerational Equity: An Exploration of the ‘Fair Innings’ Argument," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 117-132, March.
    14. Blackorby, Charles & Bossert, Walter & Donaldson, David, 1995. "Intertemporal Population Ethics: Critical-Level Utilitarian Principles," Econometrica, Econometric Society, vol. 63(6), pages 1303-1320, November.
    15. Bleichrodt, Han & Doctor, Jason & Stolk, Elly, 2005. "A nonparametric elicitation of the equity-efficiency trade-off in cost-utility analysis," Journal of Health Economics, Elsevier, vol. 24(4), pages 655-678, July.
    16. Peter C. Fishburn, 1965. "Independence in Utility Theory with Whole Product Sets," Operations Research, INFORMS, vol. 13(1), pages 28-45, February.
    17. Bleichrodt, Han, 1995. "QALYs and HYEs: Under what conditions are they equivalent?," Journal of Health Economics, Elsevier, vol. 14(1), pages 17-37, May.
    18. Daniel Kahneman & Amos Tversky, 2013. "Prospect Theory: An Analysis of Decision Under Risk," World Scientific Book Chapters, in: Leonard C MacLean & William T Ziemba (ed.), HANDBOOK OF THE FUNDAMENTALS OF FINANCIAL DECISION MAKING Part I, chapter 6, pages 99-127, World Scientific Publishing Co. Pte. Ltd..
    19. Bleichrodt, Han, 1997. "Health utility indices and equity considerations," Journal of Health Economics, Elsevier, vol. 16(1), pages 65-91, February.
    20. George W. Torrance, 1976. "Health Status Index Models: A Unified Mathematical View," Management Science, INFORMS, vol. 22(9), pages 990-1001, May.
    21. Alec Morton, 2010. "Bridging the gap: health equality and the deficit framing of health," Health Economics, John Wiley & Sons, Ltd., vol. 19(12), pages 1497-1501, December.
    22. Joseph S. Pliskin & Donald S. Shepard & Milton C. Weinstein, 1980. "Utility Functions for Life Years and Health Status," Operations Research, INFORMS, vol. 28(1), pages 206-224, February.
    23. Lambert, Peter & Zheng, Buhong, 2011. "On the consistent measurement of attainment and shortfall inequality," Journal of Health Economics, Elsevier, vol. 30(1), pages 214-219, January.
    24. Erreygers, Guido, 2009. "Can a single indicator measure both attainment and shortfall inequality?," Journal of Health Economics, Elsevier, vol. 28(4), pages 885-893, July.
    25. John M. Miyamoto & Peter P. Wakker & Han Bleichrodt & Hans J. M. Peters, 1998. "The Zero-Condition: A Simplifying Assumption in QALY Measurement and Multiattribute Utility," Management Science, INFORMS, vol. 44(6), pages 839-849, June.
    26. Ralph L. Keeney, 1974. "Multiplicative Utility Functions," Operations Research, INFORMS, vol. 22(1), pages 22-34, February.
    27. Bossert, Walter, 1990. "An axiomatization of the single-series Ginis," Journal of Economic Theory, Elsevier, vol. 50(1), pages 82-92, February.
    28. Gustavo Bergantiños & Juan D. Moreno-Ternero, 2020. "Sharing the Revenues from Broadcasting Sport Events," Management Science, INFORMS, vol. 66(6), pages 2417-2431, June.
    29. Bleichrodt, Han & Diecidue, Enrico & Quiggin, John, 2004. "Equity weights in the allocation of health care: the rank-dependent QALY model," Journal of Health Economics, Elsevier, vol. 23(1), pages 157-171, January.
    30. Karol Flores-Szwagrzak & Rafael Treibich, 2020. "Teamwork and Individual Productivity," Management Science, INFORMS, vol. 66(6), pages 2523-2544, June.
    31. Adam Turpcu & Han Bleichrodt & Quang A. Le & Jason N. Doctor, 2012. "How to Aggregate Health? Separability and the Effect of Framing," Medical Decision Making, , vol. 32(2), pages 259-265, March.
    32. Abraham Mehrez & Amiram Gafni, 1989. "Quality-adjusted Life Years, Utility Theory, and Healthy-years Equivalents," Medical Decision Making, , vol. 9(2), pages 142-149, June.
    33. Wouters, S. & van Exel, N.J.A. & Rohde, K.I.M. & Vromen, J.J. & Brouwer, W.B.F., 2017. "Acceptable health and priority weighting: Discussing a reference-level approach using sufficientarian reasoning," Social Science & Medicine, Elsevier, vol. 181(C), pages 158-167.
    34. Anand, Sudhir & Hanson, Kara, 1998. "DALYs: efficiency versus equity," World Development, Elsevier, vol. 26(2), pages 307-310, February.
    35. Asheim, Geir B. & Bossert, Walter & D'Ambrosio, Conchita & Vögele, Claus, 2020. "The measurement of resilience," Journal of Economic Theory, Elsevier, vol. 189(C).
    36. S. Fanshel & J. W. Bush, 1970. "A Health-Status Index and its Application to Health-Services Outcomes," Operations Research, INFORMS, vol. 18(6), pages 1021-1066, December.
    37. Ju, Biung-Ghi & Kim, Min & Kim, Suyi & Moreno-Ternero, Juan D., 2021. "Fair international protocols for the abatement of GHG emissions," Energy Economics, Elsevier, vol. 94(C).
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    Cited by:

    1. Hansen, Kristian S. & Moreno-Ternero, Juan D. & Østerdal, Lars P., 2023. "Productivity and quality-adjusted life years: QALYs, PALYs and beyond," Working Papers 11-2023, Copenhagen Business School, Department of Economics.
    2. Ricardo Martínez & Juan D. Moreno‐Ternero, 2024. "Redistribution with needs," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 26(1), February.
    3. Juan D. Moreno-Ternero & Lars Peter Østerdal, 2023. "Entitlements to continued life and the evaluation of population health," Review of Economic Design, Springer;Society for Economic Design, vol. 27(3), pages 561-579, September.
    4. Shaun Da Costa & Owen O'Donnell & Raf Van Gestel, 2023. "Distributionally Sensitive Measurement and Valuation of Population Health," Tinbergen Institute Discussion Papers 23-017/V, Tinbergen Institute.

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    More about this item

    Keywords

    population health; QALYs; DALYs; HYEs; axioms.;
    All these keywords.

    JEL classification:

    • D63 - Microeconomics - - Welfare Economics - - - Equity, Justice, Inequality, and Other Normative Criteria and Measurement
    • I10 - Health, Education, and Welfare - - Health - - - General

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