IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v14y2005i2p197-208.html
   My bibliography  Save this article

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

Author

Listed:
  • Paul Dolan
  • Rebecca Shaw
  • Aki Tsuchiya
  • Alan Williams

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.

Suggested Citation

  • Paul Dolan & Rebecca Shaw & Aki Tsuchiya & Alan Williams, 2005. "QALY maximisation and people's preferences: a methodological review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 197-208, February.
  • Handle: RePEc:wly:hlthec:v:14:y:2005:i:2:p:197-208
    DOI: 10.1002/hec.924
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.924
    Download Restriction: no

    File URL: https://libkey.io/10.1002/hec.924?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Busschbach, Jan J. V. & Hessing, Dick J. & De Charro, Frank Th., 1993. "The utility of health at different stages in life: A quantitative approach," Social Science & Medicine, Elsevier, vol. 37(2), pages 153-158, July.
    2. Eva Rodríguez-Míguez & José Luis Pinto, 1999. "The social value of health programs: Is age a relevant factor?," Working Papers 9904, Universidade de Vigo, Departamento de Economía Aplicada.
    3. Xavier Cuadras‐Morató & José‐Luis Pinto‐Prades & José‐María Abellán‐Perpiñán, 2001. "Equity considerations in health care: the relevance of claims," Health Economics, John Wiley & Sons, Ltd., vol. 10(3), pages 187-205, April.
    4. Tsuchiya, Aki & Dolan, Paul & Shaw, Rebecca, 2003. "Measuring people's preferences regarding ageism in health: some methodological issues and some fresh evidence," Social Science & Medicine, Elsevier, vol. 57(4), pages 687-696, August.
    5. Johannesson, Magnus & Johansson, Per-Olov, 1997. "Is the valuation of a QALY gained independent of age? Some empirical evidence," Journal of Health Economics, Elsevier, vol. 16(5), pages 589-599, October.
    6. Wagstaff, Adam, 1991. "QALYs and the equity-efficiency trade-off," Journal of Health Economics, Elsevier, vol. 10(1), pages 21-41, May.
    7. 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.
    8. Lars Lindholm & Måns Rosén, 1998. "On the measurement of the nation's equity adjusted health," Health Economics, John Wiley & Sons, Ltd., vol. 7(7), pages 621-628, November.
    9. Murray, Christopher J. L. & Acharya, Arnab K., 1997. "Understanding DALYs," Journal of Health Economics, Elsevier, vol. 16(6), pages 703-730, December.
    10. Charny, M.C. & Lewis, P.A. & Farrow, S.C., 1989. "Choosing who shall not be treated in the NHS," Social Science & Medicine, Elsevier, vol. 28(12), pages 1331-1338, January.
    11. Olsen, Jan Abel, 2000. "A note on eliciting distributive preferences for health," Journal of Health Economics, Elsevier, vol. 19(4), pages 541-550, July.
    12. 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, December.
    13. Angel González Block, Miguel Angle & Sandiford, Peter & Arturo Ruiz, José & Rovira, Joan, 2001. "Beyond health gain: : the range of health system benefits expressed by social groups in Mexico and Central America," Social Science & Medicine, Elsevier, vol. 52(10), pages 1537-1550, May.
    14. Dolan, Paul, 1998. "The measurement of individual utility and social welfare," Journal of Health Economics, Elsevier, vol. 17(1), pages 39-52, January.
    15. Labelle, Roberta J. & Hurley, Jeremiah E., 1992. "Implications of basing health-care resource allocations on cost-utility analysis in the presence of externalities," Journal of Health Economics, Elsevier, vol. 11(3), pages 259-277, October.
    16. Ubel, Peter A. & Loewenstein, George, 1996. "Distributing scarce livers: The moral reasoning of the general public," Social Science & Medicine, Elsevier, vol. 42(7), pages 1049-1055, April.
    17. Browning, Colette J. & Thomas, Shane A., 2001. "Community values and preferences in transplantation organ allocation decisions," Social Science & Medicine, Elsevier, vol. 52(6), pages 853-861, March.
    18. Anand, Paul & Wailoo, Allan, 2000. "Utilities versus Rights to Publicly Provided Goods: Arguments and Evidence from Health Care Rationing," Economica, London School of Economics and Political Science, vol. 67(268), pages 543-577, November.
    19. 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.
    20. Nord, Erik & Richardson, Jeff & Street, Andrew & Kuhse, Helga & Singer, Peter, 1995. "Maximizing health benefits vs egalitarianism: An Australian survey of health issues," Social Science & Medicine, Elsevier, vol. 41(10), pages 1429-1437, November.
    21. Olsen, Jan Abel, 1997. "Theories of justice and their implications for priority setting in health care," Journal of Health Economics, Elsevier, vol. 16(6), pages 625-639, December.
    22. Tsuchiya, Aki, 1999. "Age-related preferences and age weighting health benefits," Social Science & Medicine, Elsevier, vol. 48(2), pages 267-276, January.
    23. 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.
    24. 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.
    25. 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 243-265, May.
    26. 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, October.
    27. Aki Tsuchiya, 2001. "The value of health at different ages," Working Papers 184chedp, Centre for Health Economics, University of York.
    28. 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, August.
    29. 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.
    30. 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.
    31. Ubel, Peter A. & Loewenstein, George, 1995. "The efficacy and equity of retransplantation: an experimental survey of public attitudes," Health Policy, Elsevier, vol. 34(2), pages 145-151, November.
    32. Paul Dolan & Aki Tsuchiya, 2011. "Determining the parameters in a social welfare function using stated preference data: an application to health," Applied Economics, Taylor & Francis Journals, vol. 43(18), pages 2241-2250.
    33. 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.
    34. 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, March.
    35. 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.
    36. 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, June.
    37. 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, February.
    38. 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, January.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. 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.
    2. 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.
    3. Mira Johri & Laura J. Damschroder & Brian J. Zikmund‐Fisher & Peter A. Ubel, 2005. "The importance of age in allocating health care resources: does intervention‐type matter?," Health Economics, John Wiley & Sons, Ltd., vol. 14(7), pages 669-678, July.
    4. 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.
    5. Mæstad, Ottar & Norheim, Ole Frithjof, 2009. "Eliciting people's preferences for the distribution of health: A procedure for a more precise estimation of distributional weights," Journal of Health Economics, Elsevier, vol. 28(3), pages 570-577, May.
    6. Abellán Perpiñán, José Mª & Sánchez Martínez,Fernando I. & Martínez Pérez, Jorge E., 2007. "La medición del bienestar social relacionado con la salud/The Measurement of the Health Related Social Welfare," Estudios de Economia Aplicada, Estudios de Economia Aplicada, vol. 25, pages 927-950, Diciembre.
    7. Attema, Arthur E. & Brouwer, Werner B.F. & l’Haridon, Olivier & Pinto, Jose Luis, 2015. "Estimating sign-dependent societal preferences for quality of life," Journal of Health Economics, Elsevier, vol. 43(C), pages 229-243.
    8. Aki Tsuchiya & Richard Edlin & Paul Dolan, 2009. "Measuring the societal value of lifetime health," Working Papers 2009010, The University of Sheffield, Department of Economics, revised May 2009.
    9. Aki Tsuchiya, 2012. "Distributional Judgements in the Context of Economic Evaluation," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 38, Edward Elgar Publishing.
    10. 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.
    11. Adele Diederich & Jeannette Winkelhage & Norman Wirsik, 2011. "Age as a Criterion for Setting Priorities in Health Care? A Survey of the German Public View," PLOS ONE, Public Library of Science, vol. 6(8), pages 1-10, August.
    12. 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.
    13. Gyrd-Hansen, Dorte, 2004. "Investigating the social value of health changes," Journal of Health Economics, Elsevier, vol. 23(6), pages 1101-1116, November.
    14. 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, August.
    15. Duncan Mortimer, 2006. "The Value of Thinly Spread QALYs," PharmacoEconomics, Springer, vol. 24(9), pages 845-853, September.
    16. John McKie & Bradley Shrimpton & Jeff Richardson & Rosalind Hurworth, 2011. "The monetary value of a life year: evidence from a qualitative study of treatment costs," Health Economics, John Wiley & Sons, Ltd., vol. 20(8), pages 945-957, August.
    17. Carl Lyttkens, 2003. "Time to disable DALYs?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 4(3), pages 195-202, September.
    18. Stolk, Elly A. & Pickee, Stefan J. & Ament, Andre H.J.A. & Busschbach, Jan J.V., 2005. "Equity in health care prioritisation: An empirical inquiry into social value," Health Policy, Elsevier, vol. 74(3), pages 343-355, November.
    19. 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.
    20. 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, March.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:14:y:2005:i:2:p:197-208. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: . General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.