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QALY maximisation and people's preferences: a methodological review of the literature

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  • Paul Dolan
  • Rebecca Shaw
  • Aki Tsuchiya
  • Alan Williams

Abstract

In cost‐utility analysis, the numbers of quality‐adjusted life years (QALYs) gained are aggregated according to the sum‐ranking (or QALY maximisation) rule. This requires that the social value from health improvements is a simple product of gains in quality of life, length of life and the number of persons treated. The results from a systematic review of the literature suggest that QALY maximisation is descriptively flawed. Rather than being linear in quality and length of life, it would seem that social value diminishes in marginal increments of both. And rather than being neutral to the characteristics of people other than their propensity to generate QALYs, the social value of a health improvement seems to be higher if the person has worse lifetime health prospects and higher if that person has dependents. In addition, there is a desire to reduce inequalities in health. However, there are some uncertainties surrounding the results, particularly in relation to what might be affecting the responses, and there is the need for more studies of the general public that attempt to highlight the relative importance of various key factors. Copyright © 2004 John Wiley & Sons, Ltd.

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  • Paul Dolan & Rebecca Shaw & Aki Tsuchiya & Alan Williams, 2005. "QALY maximisation and people's preferences: a methodological review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 197-208, February.
    • Handle: RePEc:wly:hlthec:v:14:y:2005:i:2:p:197-208
    DOI: 10.1002/hec.924
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    1. Paul Anand & Allan Wailoo, 2000. "Utilities vs. Rights to Publicly Provided Goods: Arguments and Evidence from Health-Care Rationing," Open Discussion Papers in Economics 14, The Open University, Faculty of Social Sciences, Department of Economics.
    2. Peter A. Ubel & Mark D. Spranca & Michael L. Dekay & John C. Hershey & David A. Asch, 1998. "Public Preferences for Prevention versus Cure: What if an Ounce of Prevention is Worth Only an Ounce of Cure?," Medical Decision Making, , vol. 18(2), pages 141-148.
    3. Eva Rodríguez-Míguez & José Luis Pinto, 1999. "The social value of health programs: Is age a relevant factor?," Working Papers 9904, Universidade de Vigo, Departamento de Economía Aplicada.
    4. Xavier Cuadras‐Morató & José‐Luis Pinto‐Prades & José‐María Abellán‐Perpiñán, 2001. "Equity considerations in health care: the relevance of claims," Health Economics, John Wiley & Sons, Ltd., vol. 10(3), pages 187-205, April.
    5. Johannesson, Magnus & Johansson, Per-Olov, 1997. "Is the valuation of a QALY gained independent of age? Some empirical evidence," Journal of Health Economics, Elsevier, vol. 16(5), pages 589-599, October.
    6. Alan Williams, 1997. "Intergenerational Equity: An Exploration of the ‘Fair Innings’ Argument," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 117-132, March.
    7. Charny, M.C. & Lewis, P.A. & Farrow, S.C., 1989. "Choosing who shall not be treated in the NHS," Social Science & Medicine, Elsevier, vol. 28(12), pages 1331-1338, January.
    8. Peter A. Ubel & George Loewenstein, 1996. "Public Perceptions of the Importance of Prognosis in Allocating Transplantable Livers to Children," Medical Decision Making, , vol. 16(3), pages 234-241, August.
    9. Olsen, Jan Abel, 2000. "A note on eliciting distributive preferences for health," Journal of Health Economics, Elsevier, vol. 19(4), pages 541-550, July.
    10. Jose‐Maria Abellan‐Perpiñan & Jose‐Luis Pinto‐Prades, 1999. "Health state after treatment: a reason for discrimination?," Health Economics, John Wiley & Sons, Ltd., vol. 8(8), pages 701-707, December.
    11. Dolan, Paul, 1998. "The measurement of individual utility and social welfare," Journal of Health Economics, Elsevier, vol. 17(1), pages 39-52, January.
    12. Labelle, Roberta J. & Hurley, Jeremiah E., 1992. "Implications of basing health-care resource allocations on cost-utility analysis in the presence of externalities," Journal of Health Economics, Elsevier, vol. 11(3), pages 259-277, October.
    13. Ubel, Peter A. & Loewenstein, George, 1996. "Distributing scarce livers: The moral reasoning of the general public," Social Science & Medicine, Elsevier, vol. 42(7), pages 1049-1055, April.
    14. Dolan, Paul & Robinson, Angela, 2001. "The measurement of preferences over the distribution of benefits: The importance of the reference point," European Economic Review, Elsevier, vol. 45(9), pages 1697-1709, October.
    15. Shmueli, Amir, 1999. "Survival vs. quality of life: a study of the Israeli public priorities in medical care," Social Science & Medicine, Elsevier, vol. 49(3), pages 297-302, August.
    16. 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.
    17. Johannesson, Magnus & Gerdtham, Ulf-G, 1996. "A note on the estimation of the equity-efficiency trade-off for QALYs," Journal of Health Economics, Elsevier, vol. 15(3), pages 359-368, June.
    18. Ann M. Holmes, 1997. "A Method to Elicit Utilities for Interpersonal Comparisons," Medical Decision Making, , vol. 17(1), pages 10-20, February.
    19. Eva Rodríguez & José Luis Pinto, 2000. "The social value of health programmes: is age a relevant factor?," Health Economics, John Wiley & Sons, Ltd., vol. 9(7), pages 611-621, October.
    20. Nord, Erik, 1993. "The trade-off between severity of illness and treatment effect in cost-value analysis of health care," Health Policy, Elsevier, vol. 24(3), pages 227-238, August.
    21. Dolan, Paul & Olsen, Jan Abel, 2001. "Equity in health: the importance of different health streams," Journal of Health Economics, Elsevier, vol. 20(5), pages 823-834, September.
    22. Ubel, Peter A. & Loewenstein, George, 1995. "The efficacy and equity of retransplantation: an experimental survey of public attitudes," Health Policy, Elsevier, vol. 34(2), pages 145-151, November.
    23. Paul Dolan & Aki Tsuchiya, 2011. "Determining the parameters in a social welfare function using stated preference data: an application to health," Applied Economics, Taylor & Francis Journals, vol. 43(18), pages 2241-2250.
    24. Lindholm, Lars & Rosen, Mans & Emmelin, Maria, 1996. "An epidemiological approach towards measuring the trade-off between equity and efficiency in health policy," Health Policy, Elsevier, vol. 35(3), pages 205-216, March.
    25. Julie Ratcliffe, 2000. "Public preferences for the allocation of donor liver grafts for transplantation," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 137-148, March.
    26. Eva Rodríguez‐Míguez & José‐Luis Pinto‐Prades, 2002. "Measuring the social importance of concentration or dispersion of individual health benefits," Health Economics, John Wiley & Sons, Ltd., vol. 11(1), pages 43-53, January.
    27. Busschbach, Jan J. V. & Hessing, Dick J. & De Charro, Frank Th., 1993. "The utility of health at different stages in life: A quantitative approach," Social Science & Medicine, Elsevier, vol. 37(2), pages 153-158, July.
    28. Dolan, Paul & Cookson, Richard, 2000. "A qualitative study of the extent to which health gain matters when choosing between groups of patients," Health Policy, Elsevier, vol. 51(1), pages 19-30, February.
    29. Tsuchiya, Aki & Dolan, Paul & Shaw, Rebecca, 2003. "Measuring people's preferences regarding ageism in health: some methodological issues and some fresh evidence," Social Science & Medicine, Elsevier, vol. 57(4), pages 687-696, August.
    30. Wagstaff, Adam, 1991. "QALYs and the equity-efficiency trade-off," Journal of Health Economics, Elsevier, vol. 10(1), pages 21-41, May.
    31. Varekamp, I. & Krol, L. J. & Danse, J. A. C., 1998. "Age rationing for renal transplantation? The role of age in decisions regarding scarce life extending medical resources," Social Science & Medicine, Elsevier, vol. 47(1), pages 113-120, July.
    32. Lars Lindholm & Måns Rosén, 1998. "On the measurement of the nation's equity adjusted health," Health Economics, John Wiley & Sons, Ltd., vol. 7(7), pages 621-628, November.
    33. Murray, Christopher J. L. & Acharya, Arnab K., 1997. "Understanding DALYs," Journal of Health Economics, Elsevier, vol. 16(6), pages 703-730, December.
    34. Angel González Block, Miguel Angle & Sandiford, Peter & Arturo Ruiz, José & Rovira, Joan, 2001. "Beyond health gain: : the range of health system benefits expressed by social groups in Mexico and Central America," Social Science & Medicine, Elsevier, vol. 52(10), pages 1537-1550, May.
    35. Erik Nord, 1995. "The Person-trade-off Approach to Valuing Health Care Programs," Medical Decision Making, , vol. 15(3), pages 201-208, August.
    36. Browning, Colette J. & Thomas, Shane A., 2001. "Community values and preferences in transplantation organ allocation decisions," Social Science & Medicine, Elsevier, vol. 52(6), pages 853-861, March.
    37. repec:bla:econom:v:67:y:2000:i:268:p:543-77 is not listed on IDEAS
    38. Olsen, Jan Abel, 1997. "Theories of justice and their implications for priority setting in health care," Journal of Health Economics, Elsevier, vol. 16(6), pages 625-639, December.
    39. Tsuchiya, Aki, 1999. "Age-related preferences and age weighting health benefits," Social Science & Medicine, Elsevier, vol. 48(2), pages 267-276, January.
    40. Cookson, Richard & Dolan, Paul, 1999. "Public views on health care rationing: a group discussion study," Health Policy, Elsevier, vol. 49(1-2), pages 63-74, September.
    41. Cropper, Maureen L & Aydede, Sema K & Portney, Paul R, 1994. "Preferences for Life Saving Programs: How the Public Discounts Time and Age," Journal of Risk and Uncertainty, Springer, vol. 8(3), pages 243-265, May.
    42. Aki Tsuchiya, 2001. "The value of health at different ages," Working Papers 184chedp, Centre for Health Economics, University of York.
    43. Fredrik Andersson & Carl Hampus Lyttkens, 1999. "Preferences for equity in health behind a veil of ignorance," Health Economics, John Wiley & Sons, Ltd., vol. 8(5), pages 369-378, August.
    44. Culyer, A. J. & Wagstaff, Adam, 1993. "Equity and equality in health and health care," Journal of Health Economics, Elsevier, vol. 12(4), pages 431-457, December.
    45. Paul Dolan & Colin Green, 1998. "Using the person trade‐off approach to examine differences between individual and social values," Health Economics, John Wiley & Sons, Ltd., vol. 7(4), pages 307-312, June.
    46. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39, February.
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