The additive utility assumption of the QALY model revisited

Gandjour, Afschin; Gafni, Amiram

doi:10.1016/j.jhealeco.2009.11.001

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…Another limitation relates to selection bias in online surveys, which is particularly challenging for experimental studies [36]. In this study, low socioeconomic status is associated with dropping out and nontrading behavior (e.g., always choosing the alternative with the longest life span), which may be attributable to preferences, a lack of attention, or increased cognitive difficulty.…”

Section: Study Limitationsmentioning

confidence: 87%

Quality-Adjusted Life-Years without Constant Proportionality

et al. 2018

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Section: Study Limitationsmentioning

confidence: 87%

Quality-Adjusted Life-Years without Constant Proportionality

et al. 2018

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“…Given the growing interest in the application of MCDA to medical decision making, it is important that MCDA practitioners and clinicians understand a model’s limitations, pitfalls, and practical difficulties to choose one adequate to the context. 48 Publication of the 2 ISPOR MCDA Emerging Good Practices Task Force reports 6,7 has not stopped the proliferation of publications with additive MCDA models for life-critical medical decision making. This is a case in point of theory-induced blindness:Once you have accepted a theory and used it as a tool in your thinking, it is extraordinarily difficult to notice its flaws.…”

Section: Discussionmentioning

confidence: 99%

“…38,41,42 For nonchronic diseases, the de facto method is to treat each different health stage as a chronic disease and to sum the QALYs to obtain the overall QALE. [46][47][48] There is evidence to challenge it, but it is still regarded as the ''most rigorous methodological tool'' available for medical decision making. 45 Complex models that incorporate correlations among health states in different time periods have recently been proposed.…”

Section: Discussionmentioning

confidence: 99%

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Additive Multicriteria Decision Analysis Models: Misleading Aids for Life-Critical Shared Decision Making

2019

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Background. There is growing interest in multicriteria decision analysis (MCDA) for shared decision making (SDM). A distinguishing feature is that a preferred treatment should extend years of life and/or improve health-related quality of life (HRQL). Additive MCDA models are inadequate for the task. A plethora of MCDA models exist, each claiming that it can correctly solve real-world problems. However, most were developed in nonhealth fields and rely on additive models. This makes the problem of choosing an MCDA model as an aid for SDM a challenging and urgent one. Methods. A published 2017 MCDA of a hypothetical prostate cancer patient is used as a case in point of how not to do and how to do MCDA for SDM. We critically review it and analyze it using several additive linear MCDA models with years of life and HRQL as attributes and the linear quality-adjusted life-year (QALY) model. The following simple reasonableness test is presented for applicability of a method as an aid for SDM: Can a treatment that causes premature death trump a treatment that causes acceptable adverse effects? Results. Additive MCDA models and the linear QALY recommend significantly different alternatives. Additive MCDA models fail the proposed reasonableness test; the linear QALY model passes. Conclusions. MCDA possesses a strong craft element in addition to its technical aspects. MCDA practitioners and clinicians need to understand model limitations to choose models appropriate to the context. Additive MCDA models are inadequate for life-critical SDM. We advocate QALY models with additional research for increased realism as a tool for SDM.

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“…Health improvement is the single most important benefit from using health care services; the QALY is a practical tool for measuring this. The use of QALYs, however, does rest on some important underlying assumptions (Gandjour and Gafni, 2010) and their use is not without challenges both in measuring and valuing health states. For example, NICE notes the challenges involved in measuring and valuing health related quality of life in children, and indicates this as a reason why children are given special consideration in its health technology assessment process (Rawlins, et al, 2010).…”

Section: What Elements Of Value Are Likely To Matter?mentioning

confidence: 99%

Operationalising Value Based Pricing of Medicines: A Taxonomy of Approaches

2011

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The purpose of this paper is to provide an account of the full set of possible means by which value based pricing (VBP) might be operationalised; to describe and categorise them by developing a taxonomy of approaches; to give an initial assessment of the challenges, pros and cons that each of the principal types of approach implies. To achieve this, we review the elements of value that could be taken into account, how they might be measured and valued, how the different elements could be combined into an overall assessment of a medicine's value, and how that then could be linked to the maximum price the health service is willing to reimburse.The UK Department of Health's consultation document regarding the introduction of VBP (DH, 2010a) outlines one possible approach to these steps -but others are possible.We begin with a brief discussion of value in economics and theoretical frameworks from economics relevant to the normative question of which attributes of medicines should be taken into account in VBP.We proceed to outline a taxonomy of approaches to VBP, taking as our starting point that VBP will include a measure of health gain and that this will be built on the QALY. Our principal interest is in the way criteria other than QALYs are taken into account. We set out to: (i) identify and describe the full range of alternative means by which "value" might be measured and valued, (ii) identify and describe the options available for aggregating the different components of value to establish a maximum price, and (iii) note the challenges and relative advantages associated with these approaches. Finally, we review the means by which VBP is currently operationalised in a selection of countries and place these, and proposals for the UK, in the context of our taxonomy.

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The additive utility assumption of the QALY model revisited

Cited by 5 publications

References 15 publications

Quality-Adjusted Life-Years without Constant Proportionality

Quality-Adjusted Life-Years without Constant Proportionality

Additive Multicriteria Decision Analysis Models: Misleading Aids for Life-Critical Shared Decision Making

Operationalising Value Based Pricing of Medicines: A Taxonomy of Approaches

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