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Models of Quality‐Adjusted Life Years when Health Varies Over Time: Survey and Analysis

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  • Kristian Schultz Hansen
  • Lars Peter Østerdal

Abstract

. Quality‐adjusted life year (QALY) models are widely used for economic evaluation in the health care sector. In the first part of the paper, we establish an overview of QALY models where health varies over time and provide a theoretical analysis of model identification and parameter estimation from time trade‐off (TTO) and standard gamble (SG) scores. We investigate deterministic and probabilistic models and consider five different families of discounting functions in all. The second part of the paper discusses four issues recurrently debated in the literature. This discussion includes questioning the SG method as the gold standard for estimation of the health state index, re‐examining the role of the constant‐proportional trade‐off condition, revisiting the problem of double discounting of QALYs, and suggesting that it is not a matter of choosing between TTO and SG procedures as the combination of these two can be used to disentangle risk aversion from discounting. We find that caution must be taken when drawing conclusions from models with chronic health states to situations where health varies over time. One notable difference is that in the former case, risk aversion may be indistinguishable from discounting.

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  • Kristian Schultz Hansen & Lars Peter Østerdal, 2006. "Models of Quality‐Adjusted Life Years when Health Varies Over Time: Survey and Analysis," Journal of Economic Surveys, Wiley Blackwell, vol. 20(2), pages 229-255, April.
    • Handle: RePEc:bla:jecsur:v:20:y:2006:i:2:p:229-255
    DOI: 10.1111/j.0950-0804.2006.00279.x
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    2. Arthur E. Attema & Han Bleichrodt & Peter P. Wakker, 2012. "A Direct Method for Measuring Discounting and QALYs More Easily and Reliably," Medical Decision Making, , vol. 32(4), pages 583-593, July.
    3. Lars Østerdal, 2009. "The lack of theoretical support for using person trade-offs in QALY-type models," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(4), pages 429-436, October.
    4. Stefan A. Lipman & Werner B.F. Brouwer & Arthur E. Attema, 2019. "QALYs without bias? Nonparametric correction of time trade‐off and standard gamble weights based on prospect theory," Health Economics, John Wiley & Sons, Ltd., vol. 28(7), pages 843-854, July.
    5. Arthur E. Attema & Werner B. F. Brouwer, 2008. "Can we fix it? Yes we can! But what? A new test of procedural invariance in TTO‐measurement," Health Economics, John Wiley & Sons, Ltd., vol. 17(7), pages 877-885, July.
    6. Attema, Arthur E. & Brouwer, Werner B.F., 2009. "The correction of TTO-scores for utility curvature using a risk-free utility elicitation method," Journal of Health Economics, Elsevier, vol. 28(1), pages 234-243, January.

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