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The importance of Perspective in the Measurement of Quality-adjusted Life Years

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  • Jeff Richardson
  • Erik Nord

Abstract

Scaling instruments for the measurement of quality-adjusted life years (QALYs) incor porate either a personal or an impersonal perspective on the benefits of a health intervention and either do or do not incorporate considerations of equity. This paper sets out three hypotheses concerning perspective and equity: 1) that more equally distributed benefits will be preferred to less equally distributed benefits; 2) that the preference value elicited for a health benefit will be greater when the respondent to a QALY questionnaire is a potential beneficiary; and 3) that, by comparison with personal preferences, individuals will be more concerned with the quantity than the quality of life in other people. These hypotheses were tested using two existing instruments and two other instruments that were created for this study. Results gave no support to the third hypothesis; some support to the first hypothesis, and strong support for the sec ond hypothesis. It is concluded that perspective can significantly alter the values in corporated in a QALY instrument. The policy implications of the results are twofold. First, they give some support to the view that distributional consequences of health programs are of importance to the population and that they should be included in the evaluation of any health program. Second, they indicate that an evaluation should consider whether the health-state values to be obtained should incorporate an imper sonal perspective reflecting the purely "social" judgment of a health planner or a per spective reflecting self-interest. Key words: quality-adjusted life years; scaling instru ments ; equity; preferences; policy. (Med Decis Making 1997;17:33-41)

Suggested Citation

  • Jeff Richardson & Erik Nord, 1997. "The importance of Perspective in the Measurement of Quality-adjusted Life Years," Medical Decision Making, , vol. 17(1), pages 33-41, February.
    • Handle: RePEc:sae:medema:v:17:y:1997:i:1:p:33-41
    DOI: 10.1177/0272989X9701700104
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    References listed on IDEAS

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    1. Richardson, J., 1994. "Cost utility analysis: What should be measured?," Social Science & Medicine, Elsevier, vol. 39(1), pages 7-21, July.
    2. Nord, Erik & Richardson, Jeff & Street, Andrew & Kuhse, Helga & Singer, Peter, 1995. "Maximizing health benefits vs egalitarianism: An Australian survey of health issues," Social Science & Medicine, Elsevier, vol. 41(10), pages 1429-1437, November.
    3. Jan Abel Olsen, 1994. "Persons vs years: Two ways of eliciting implicit weights," Health Economics, John Wiley & Sons, Ltd., vol. 3(1), pages 39-46, January.
    4. 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.
    5. J. Richardson, 1991. "Economic Assessment of Health Care: Theory and Practice," Australian Economic Review, The University of Melbourne, Melbourne Institute of Applied Economic and Social Research, vol. 24(1), pages 4-21, January.
    6. Erik Nord, 1994. "The qaly—a measure of social value rather than individual utility?," Health Economics, John Wiley & Sons, Ltd., vol. 3(2), pages 89-93, March.
    7. Nord, Erik, 1992. "Methods for quality adjustment of life years," Social Science & Medicine, Elsevier, vol. 34(5), pages 559-569, March.
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    Cited by:

    1. Abellán Perpiñán, José Mª & Sánchez Martínez,Fernando I. & Martínez Pérez, Jorge E., 2007. "La medición del bienestar social relacionado con la salud/The Measurement of the Health Related Social Welfare," Estudios de Economia Aplicada, Estudios de Economia Aplicada, vol. 25, pages 927-950, Diciembre.
    2. Michaël Schwarzinger & Jean‐Louis Lanoë & Erik Nord & Isabelle Durand‐Zaleski, 2004. "Lack of multiplicative transitivity in person trade‐off responses," Health Economics, John Wiley & Sons, Ltd., vol. 13(2), pages 171-181, February.
    3. Thornton Snider Julia & Romley John A. & Vogt William B. & Philipson Tomas J., 2012. "The Option Value of Innovation," Forum for Health Economics & Policy, De Gruyter, vol. 15(1), pages 1-19, April.
    4. Lori J. Curtis & Martin D. Dooley & Ellen L. Lipman & David H. Feeny, 2001. "The role of permanent income and family structure in the determination of child health in Canada," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 287-302, June.
    5. Ubel, Peter A. & Loewenstein, George & Scanlon, Dennis & Kamlet, Mark, 1998. "Value measurement in cost-utility analysis: explaining the discrepancy between rating scale and person trade-off elicitations," Health Policy, Elsevier, vol. 43(1), pages 33-44, January.
    6. Lori Curtis & Martin D. Dooley & Ellen L. Lipman & David H. Feeny, "undated". "The Role of Permanent Income and Family Structure in the Determination of Child Health in the Ontario Child Health Study," Canadian International Labour Network Working Papers 16, McMaster University.
    7. Lars Østerdal, 2009. "The lack of theoretical support for using person trade-offs in QALY-type models," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(4), pages 429-436, October.
    8. Stefanos A. Zenios & Glenn M. Chertow & Lawrence M. Wein, 2000. "Dynamic Allocation of Kidneys to Candidates on the Transplant Waiting List," Operations Research, INFORMS, vol. 48(4), pages 549-569, August.
    9. Lars Peter Østerdal, 2004. "QALYs, Person Trade-Offs, and the Pareto Principle," Discussion Papers 04-10, University of Copenhagen. Department of Economics.
    10. Christopher J.L. Murray & David B. Evans & Arnab Acharya & Rob M.P.M. Baltussen, 2000. "Development of WHO guidelines on generalized cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 9(3), pages 235-251, April.
    11. Paul Dolan & Jan Abel Olsen & Paul Menzel & Jeff Richardson, 2003. "An inquiry into the different perspectives that can be used when eliciting preferences in health," Health Economics, John Wiley & Sons, Ltd., vol. 12(7), pages 545-551, July.
    12. Paul Dolan & Aki Tsuchiya, 2003. "The person trade‐off method and the transitivity principle: an example from preferences over age weighting," Health Economics, John Wiley & Sons, Ltd., vol. 12(6), pages 505-510, June.
    13. Jonathan Karnon & Nawab Qizilbash, 2001. "Economic evaluation alongside n‐of‐1 trials: getting closer to the margin," Health Economics, John Wiley & Sons, Ltd., vol. 10(1), pages 79-82, January.

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