Valuing QALYs at the end of life

Abstract

The possibility of weighting QALYs differently for different groups of patients has been a source of debate. Most recently, this debate has been extended to the relative value of QALYs at the end of life (EoL). The objective of this study is to provide evidence of societal preferences in relation to this topic. Three cross-sectional surveys were conducted amongst Spanish general population (n = 813). Survey 1 compared increases in life expectancy for EoL patients with health gains from temporary health problems. Survey 2 compared health gains for temporary health problems with quality of life gains at the EoL (palliative care). Survey 3 compared increases in life expectancy with quality of life gains, both for EoL patients. Preferences were elicited using Person Trade-Off (PTO) and Willingness to pay (WTP) techniques presenting two different durations of health benefit (6 and 18 months). Health benefits, measured in QALYs, were held constant in all comparisons. In survey 1 mean WTP was higher for life extending treatments than for temporary health problems and the majority of respondents prioritised life extension over temporary health problems in response to the PTO questions. In survey 2 mean WTP was higher for palliative care than for temporary health problems and 83% prioritized palliative care (for both durations) in the PTO questions. In survey 3 WTP values were higher for palliative care than for life extending treatments and more than 60% prioritized palliative care in the PTO questions. Our results suggest that QALYs gained from EoL treatments have a higher social value than QALYs gained from treatments for temporary health problems. Further, we found that people attach greater weight to improvements in quality of life than to life extension at the end of life.

Valuing health at the end of life: A stated preference discrete choice experiment

“…In response to concerns expressed during the consultation that there is little evidence to support the premise that society is prepared to fund life-extending end-of-life treatments that would not meet the cost-effectiveness criteria used for other treatments (NICE, 2009b), a few studies of people's preferences regarding endof-life have been undertaken in the UK (Linley and Hughes, 2013;Brazier et al, 2013) and elsewhere (Olsen, 2013;Pinto-Prades et al, 2014). The findings are mixed, with evidence of support for an end-of-life premium reported by Brazier et al (2013) andPinto Prades et al (2014) but not by Linley and Hughes (2013) or Olsen (2013).…”

“…The findings are mixed, with evidence of support for an end-of-life premium reported by Brazier et al (2013) andPinto Prades et al (2014) but not by Linley and Hughes (2013) or Olsen (2013). Notwithstanding these recent additions to the empirical literature, the evidence remains limited and there have been calls for further exploration of the issues (Green, 2011).…”

Reliability and Validity of Hypothetical Scenarios for Estimating Willingness to Pay (Wtp) Per Quality Adjusted Life Year (Qaly) in Indonesia Setting

“…Many studies suggested that hypothetical willingness-to-pay typically overestimates real willingness-to-pay [16,22]. Participants may exaggerate willingness-to-pay values and in real life do not necessarily behave the same way as stated in their responses [23].…”

Cost-utility analysis of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) in combination with gemcitabine in metastatic pancreatic cancer in Spain: results of the PANCOSTABRAX study

“…First, the potential improvement in health tends to be low; second, gains in health usually occur for only a short period; third, the patients these treatments are aimed at are usually in the final stages of life. If, due to these reasons, QALYs do not fully capture the social value of anticancer drugs, the fact that their cost per QALY is higher than many other drugs may not be a definitive argument for decisions to recommend these treatments or not [21].…”

“…For these reasons, and according to the discussion on the need to incorporate measures that allow the inclusion of aspects, such as the burden of disease in the economic evaluation of health technologies [21,23,24], a scenario in which the QALYs obtained due to an intervention were weighted for this purpose was included in the sensitivity analysis. Specifically, a methodology discussed by NICE to explicitly and systematically incorporate the concept of the disease burden according to the relation between the expected total of QALYs lost due to the disease and the total QALYs expected for the population of the same age and gender without the disease was used.…”