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A utility‐theoretic model for QALYs and willingness to pay

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  • Thomas Klose

Abstract

Despite the widespread use of quality‐adjusted life years (QALY) in economic evaluation studies, their utility‐theoretic foundation remains unclear. A model for preferences over health, money, and time is presented in this paper. Under the usual assumptions of the original QALY‐model, an additive separable presentation of the utilities in different periods exists. In contrast to the usual assumption that QALY‐weights do solely depend on aspects of health‐related quality of life, wealth‐standardized QALY‐weights might vary with the wealth level in the presented extension of the original QALY‐model resulting in an inconsistent measurement of QALYs. Further assumptions are presented to make the measurement of QALYs consistent with lifetime preferences over health and money. Even under these strict assumptions, QALYs and WTP (which also can be defined in this utility‐theoretic model) are not equivalent preference‐based measures of the effects of health technologies on an individual level. The results suggest that the individual WTP per QALY can depend on the magnitude of the QALY‐gain as well as on the disease burden, when health influences the marginal utility of wealth. Further research seems to be indicated on this structural aspect of preferences over health and wealth and to quantify its impact. Copyright © 2002 John Wiley & Sons, Ltd.

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  • Thomas Klose, 2003. "A utility‐theoretic model for QALYs and willingness to pay," Health Economics, John Wiley & Sons, Ltd., vol. 12(1), pages 17-31, January.
    • Handle: RePEc:wly:hlthec:v:12:y:2003:i:1:p:17-31
    DOI: 10.1002/hec.697
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    1. Johansson,Per-Olov, 1995. "Evaluating Health Risks," Cambridge Books, Cambridge University Press, number 9780521478786, September.
    2. Donald L. Patrick & Helene E. Starks & Kevin C. Cain & Richard F. Uhlmann & Robert A. Pearlman, 1994. "Measuring Preferences for Health States Worse than Death," Medical Decision Making, , vol. 14(1), pages 9-18, February.
    3. Evans, William N & Viscusi, W Kip, 1991. "Estimation of State-Dependent Utility Functions Using Survey Data," The Review of Economics and Statistics, MIT Press, vol. 73(1), pages 94-104, February.
    4. Viscusi, W Kip & Evans, William N, 1990. "Utility Functions That Depend on Health Status: Estimates and Economic Implications," American Economic Review, American Economic Association, vol. 80(3), pages 353-374, June.
    5. Mark S. Thompson, 1983. "Health Versus Money," Medical Decision Making, , vol. 3(3), pages 285-297, August.
    6. Keeney,Ralph L. & Raiffa,Howard, 1993. "Decisions with Multiple Objectives," Cambridge Books, Cambridge University Press, number 9780521438834, September.
    7. Charles Blackorby & David Donaldson & David Moloney, 1984. "Consumer's Surplus and Welfare Change in a Simple Dynamic Model," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 51(1), pages 171-176.
    8. Joseph S. Pliskin & Donald S. Shepard & Milton C. Weinstein, 1980. "Utility Functions for Life Years and Health Status," Operations Research, INFORMS, vol. 28(1), pages 206-224, February.
    9. Orazio Attanasio & James Banks, 1998. "Trends in household saving don’t justify tax incentives to boost saving," Economic Policy, CEPR, CESifo, Sciences Po;CES;MSH, vol. 13(27), pages 548-583.
    10. David Meltzer, 1997. "Accounting for Future Costs in Medical Cost-Effectiveness Analysis," NBER Working Papers 5946, National Bureau of Economic Research, Inc.
    11. John M. Miyamoto & Stephen A. Eraker, 1985. "Parameter Estimates for a QALY Utility Model," Medical Decision Making, , vol. 5(2), pages 191-213, June.
    12. Culyer, A J, 1989. "The Normative Economics of Health Care Finance and Provision," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 5(1), pages 34-58, Spring.
    13. Keen, Michael, 1990. "Welfare analysis and intertemporal substitution," Journal of Public Economics, Elsevier, vol. 42(1), pages 47-66, June.
    14. Johansson,Per-Olov, 1995. "Evaluating Health Risks," Cambridge Books, Cambridge University Press, number 9780521472852, September.
    15. Garber, Alan M. & Phelps, Charles E., 1997. "Economic foundations of cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 1-31, February.
    16. S Georgiou & I H Langford & I J Bateman & R K Turner, 1998. "Determinants of Individuals' Willingness to Pay for Perceived Reductions in Environmental Health Risks: A Case Study of Bathing Water Quality," Environment and Planning A, , vol. 30(4), pages 577-594, April.
    17. Michael Grossman, 1972. "The Demand for Health: A Theoretical and Empirical Investigation," NBER Books, National Bureau of Economic Research, Inc, number gros72-1.
    18. Meltzer, David, 1997. "Accounting for future costs in medical cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 33-64, February.
    19. Johannesson, Magnus, 1996. "A note on the relationship between ex ante and expected willingness to pay for health care," Social Science & Medicine, Elsevier, vol. 42(3), pages 305-311, February.
    20. Klose, Thomas, 1999. "The contingent valuation method in health care," Health Policy, Elsevier, vol. 47(2), pages 97-123, May.
    21. Olsen, Jan Abel & Donaldson, Cam, 1998. "Helicopters, hearts and hips: Using willingness to pay to set priorities for public sector health care programmes," Social Science & Medicine, Elsevier, vol. 46(1), pages 1-12, January.
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    2. George Van Houtven & John Powers & Amber Jessup & Jui‐Chen Yang, 2006. "Valuing avoided morbidity using meta‐regression analysis: what can health status measures and QALYs tell us about WTP?," Health Economics, John Wiley & Sons, Ltd., vol. 15(8), pages 775-795, August.
    3. Kanya, Lucy & Sanghera, Sabina & Lewin, Alex & Fox-Rushby, Julia, 2019. "The criterion validity of willingness to pay methods: A systematic review and meta-analysis of the evidence," Social Science & Medicine, Elsevier, vol. 232(C), pages 238-261.
    4. Somayeh Sadat & Hossein Abouee-Mehrizi & Michael Carter, 2015. "Can hospitals compete on quality?," Health Care Management Science, Springer, vol. 18(3), pages 376-388, September.
    5. Kanya, Lucy & Saghera, Sabina & Lewin, Alex & Fox-Rushby, Julia, 2019. "The criterion validity of willingness to pay methods: a systematic review and meta-analysis of the evidence," LSE Research Online Documents on Economics 100741, London School of Economics and Political Science, LSE Library.
    6. José‐María Abellán‐Perpiñán & José‐Luis Pinto‐Prades & Ildefonso Méndez‐Martínez & Xabier Badía‐Llach, 2006. "Towards a better QALY model," Health Economics, John Wiley & Sons, Ltd., vol. 15(7), pages 665-676, July.
    7. Christian R. C. Kouakou & Thomas G. Poder, 2022. "Willingness to pay for a quality-adjusted life year: a systematic review with meta-regression," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(2), pages 277-299, March.

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