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QALYs versus HYEs - a theoretical exposition

Listed author(s):
  • Tony J Culyer
  • Adam Wagstaff

There has been a vigorous dispute about quality adjusted life years (QALYs) and it has been argued that they are an inappropriate measure of patient utility and that a more efficient approach is to measure outcomes in terms of health year equivalents (HYEs). This paper explores the theoretical underpinning of this debate. It explores the claim that QALYs are liable to misrepresent consumer preferences and hence lead to decision-makers choosing options which are not those preferred by the public. It also considers the claim that HYEs do not suffer from this defect. We argue that none of the examples offered to date demonstrate the alleged tendency of QALYs to misinterpret preferences. We also suggest that although QALYs may misinterpret preferences in a way that HYEs do not, since they require that the individual’s utility function be additively separable over time, there is no evidence to date that QALYs do so.

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File Function: First version, 1992
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Paper provided by Centre for Health Economics, University of York in its series Working Papers with number 099chedp.

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Length: 14 pages
Date of creation: Sep 1992
Handle: RePEc:chy:respap:99chedp
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  1. 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.
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