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Establishing health state valuations for disease specific states: an example from heart disease


  • J. Kirsch

    (SmithKline Beecham Limited, Mundells, Welwyn Garden City, UK)

  • A. McGuire

    (City University, London, UK)


This study considers the feasibility of defining a QALY from disease-specific data using the New York Heart Association (NYHA) classification of heart failure. The study derives health state values for the four different NYHA classifications of disease progression using the time trade-off (TTO) instrument associated with the five dimensional (EQ-5D) health state valuation method. Consistent mappings between the disease classification and the chosen QALY instrument are found. With this being the case, the assumption of constant proportionality, which is necessary to define the QALY as an acceptable measure of health related preferences, is considered. It is found that constant proportionality does not hold across the more severe health states, thus questioning the use of QALYs as representing cardinal preference structures. Copyright © 2000 John Wiley & Sons, Ltd.

Suggested Citation

  • J. Kirsch & A. McGuire, 2000. "Establishing health state valuations for disease specific states: an example from heart disease," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 149-158.
  • Handle: RePEc:wly:hlthec:v:9:y:2000:i:2:p:149-158 DOI: 10.1002/(SICI)1099-1050(200003)9:2<149::AID-HEC501>3.0.CO;2-N

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    References listed on IDEAS

    1. Claire Gudex, 1994. "Time trade-off user manual: props and self-completion methods," Working Papers 020cheop, Centre for Health Economics, University of York.
    2. Torrance, George W., 1986. "Measurement of health state utilities for economic appraisal : A review," Journal of Health Economics, Elsevier, vol. 5(1), pages 1-30, March.
    3. Dolan, P. & Gudex, C. & Kind, P. & Williams, A., 1996. "Valuing health states: A comparison of methods," Journal of Health Economics, Elsevier, vol. 15(2), pages 209-231, April.
    4. Wagstaff, Adam, 1991. "QALYs and the equity-efficiency trade-off," Journal of Health Economics, Elsevier, vol. 10(1), pages 21-41, May.
    5. Garber, Alan M. & Phelps, Charles E., 1997. "Economic foundations of cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 1-31, February.
    6. Kenkel, Don, 1997. "On valuing morbidity, cost-effectiveness analysis, and being rude," Journal of Health Economics, Elsevier, vol. 16(6), pages 749-757, December.
    7. Machina, Mark J, 1987. "Choice under Uncertainty: Problems Solved and Unsolved," Journal of Economic Perspectives, American Economic Association, vol. 1(1), pages 121-154, Summer.
    8. Bleichrodt, Han & Johannesson, Magnus, 1997. "Standard gamble, time trade-off and rating scale: Experimental results on the ranking properties of QALYs," Journal of Health Economics, Elsevier, vol. 16(2), pages 155-175, April.
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    Cited by:

    1. Attema, Arthur E. & Brouwer, Werner B.F., 2012. "A test of independence of discounting from quality of life," Journal of Health Economics, Elsevier, vol. 31(1), pages 22-34.
    2. José-María Abellán-Perpiñán & José-Luis Pinto-Prades & Ildefonso Méndez-Martínez & Xabier Badía-Llach, 2006. "Towards a better QALY model," Health Economics, John Wiley & Sons, Ltd., vol. 15(7), pages 665-676.
    3. F. Tomini & F. Prinzen & A. D. I. Asselt, 2016. "A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(9), pages 1159-1172, December.
    4. Nikos Maniadakis & Mattias Ekman & Vasilios Fragoulakis & Vasiliki Papagiannopoulou & John Yfantopoulos, 2011. "Economic evaluation of irbesartan in combination with hydrochlorothiazide in the treatment of hypertension in Greece," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(3), pages 253-261, June.
    5. Peter S Hall & Richard Edlin & Samer Kharroubi & Walter Gregory & Christopher McCabe, 2011. "Expected Net Present Value of Sample Information: from burden to investment," Working Papers 1101, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds.

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