Incorporating societal concerns for fairness in numerical valuations of health programmes

Abstract

The paper addresses some limitations of the QALY approach and outlines a valuation procedure that may overcome these limitations. In particular, we focus on the following issues: the distinction between assessing individual utility and assessing societal value of health care; the need to incorporate concerns for severity of illness as an independent factor in a numerical model of societal valuations of health outcomes; similarly, the need to incorporate reluctance to discriminate against patients that happen to have lesser potentials for health than others; and finally, the need to combine measurements of health-related quality of life obtained from actual patients (or former patients) with measurements of distributive preferences in the general population when estimating societal value. We show how equity weights may serve to incorporate concerns for severity and potentials for health in QALY calculations. We also suggest that for chronically ill or disabled people a life year gained should count as one and no less than one as long as the year is considered preferable to being dead by the person concerned. We call our approach 'cost-value analysis'.

Social preferences for prioritizing the treatment of severely ill patients: The relevance of severity, expected benefit, past health and lifetime health

“…The results thus support the Norwegian government's decision not to pursue a lifetime health-loss criterion as recommended by the Norheim Commission, and are consistent with empirical findings that show a significant discounting of prior health state when prioritizing life-saving programs (Arnesen and Nord 1999;Ubel, Richardson et al 1999;Nord, Undrum Enge et al 2010). This position has also been supported by ethical arguments (Menzel, Gold et al 1999;Nord, Pinto et al 1999).…”

Technology and Outcomes Assessment in Lung Transplantation

“…The questionnaires use the population's preference values to weight the data from the completed questionnaires and produce estimates of utilities (21,22). Some experts argue that the most appropriate valuation elicitations come from people who are currently experiencing the health states for which values are sought (23). However, patient values may be subject to self-interest and other biases.…”

Cost-effectiveness of Dapagliflozin for the Treatment of Heart Failure With Reduced Ejection Fraction

“… a As the use of QALYs may undervalue prolonged survival among individuals with imperfect quality-of-life at baseline, we also computed the incremental cost evLYG, an approach that assumes that any extension of life has a perfect quality-of-life …”