IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v2y1993i1p59-64.html
   My bibliography  Save this article

Qaly league tables: Handle with care

Author

Listed:
  • Karen Gerard
  • Gavin Mooney

Abstract

This paper examines some of the difficulties in using QALY league tables in priority setting. Such tables sometimes are seen as being ‘the’ way to prioritise in health care and in particular, at present, with respect to priority setting among purchasers in the UK NHS. However the paper highlights the fact that the base on which such tables is built is small—relatively few studies in the English language using CUA have been conducted anywhere. Further, four issues which require handling with care are set out: (i) the relevant measure of cost in QALY league tables has to be restricted to health service resource use; (ii) the relevant measure of benefit in QALY league tables is clearly restricted to QALYs, thereby the utility of health gains and indeed the maximisation of the utility of health gains; (iii) in incorporating the results of CUA studies into QALY league tables there is a need for greater clarification on what the margin constitutes; and (iv) those who might use CUA results in QALY league tables need to ascertain whether the original context of the study will allow the results to be transferred to the local context of the decision maker. The paper suggests that there is a need to be quite clear what goal QALY league tables serve. The authors argue that the only legitimate (and clearly important) goal of QALY league tables is the maximisation of the utility of health gains within a health service budget. The thinking underlying QALY league tables, adjusted to take account of the caveats in this paper, is the key to rational priority setting at a local level. It is this thinking that is to be emphasised rather than the use of ‘imported’ league tables or the use of results from CUA studies conducted elsewhere in the country or indeed in other countries. If results from elsewhere are to be used, the study context has to be examined carefully to establish the extent of its relevance to the local circumstances facing the purchasing authority.

Suggested Citation

  • Karen Gerard & Gavin Mooney, 1993. "Qaly league tables: Handle with care," Health Economics, John Wiley & Sons, Ltd., vol. 2(1), pages 59-64, April.
    • Handle: RePEc:wly:hlthec:v:2:y:1993:i:1:p:59-64
    DOI: 10.1002/hec.4730020108
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.4730020108
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hec.4730020108?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Gerard, Karen, 1992. "Cost-utility in practice: A policy maker's guide to the state of the art," Health Policy, Elsevier, vol. 21(3), pages 249-279, July.
    2. Loomes, Graham & McKenzie, Lynda, 1989. "The use of QALYs in health care decision making," Social Science & Medicine, Elsevier, vol. 28(4), pages 299-308, January.
    3. Bryan, Stirling & Parkin, David & Donaldson, Cam, 1991. "Chiropody and the QALY: a case study in assigning categories of disability and distress to patients," Health Policy, Elsevier, vol. 18(2), pages 169-185, July.
    4. Maynard, Alan, 1991. "Developing the Health Care Market," Economic Journal, Royal Economic Society, vol. 101(408), pages 1277-1286, September.
    5. 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.
    6. S Birch & A Gafni, 1991. "Cost Effectiveness/Utility Analyses: Do Current Decision Rules Lead us to Where We Want to Be?," Centre for Health Economics and Policy Analysis Working Paper Series 1991-06, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Hougaard, Jens Leth & Moreno-Ternero, Juan D. & Østerdal, Lars Peter, 2013. "A new axiomatic approach to the evaluation of population health," Journal of Health Economics, Elsevier, vol. 32(3), pages 515-523.
    2. Mark Sculpher & Amiram Gafni, 2001. "Recognizing diversity in public preferences: The use of preference sub‐groups in cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 317-324, June.
    3. Stavros Petrou & Christine Hockley, 2005. "An investigation into the empirical validity of the EQ‐5D and SF‐6D based on hypothetical preferences in a general population," Health Economics, John Wiley & Sons, Ltd., vol. 14(11), pages 1169-1189, November.
    4. Meltzer, David, 1997. "Accounting for future costs in medical cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 33-64, February.
    5. James K. Hammitt, 2002. "QALYs Versus WTP," Risk Analysis, John Wiley & Sons, vol. 22(5), pages 985-1001, October.
    6. Kobelt, G., 2013. "Health Economics: An Introduction to Economic Evaluation," Monographs, Office of Health Economics, number 000004.
    7. Shackley, Phil & Cairns, John, 1996. "Evaluating the benefits of antenatal screening: an alternative approach," Health Policy, Elsevier, vol. 36(2), pages 103-115, May.
    8. José Mª Abellán & José Luis Pinto & Ildefonso Méndez & Xabier Badía, 2004. "A test of the predictive validity of non-linear QALY models using time trade-off utilities," Economics Working Papers 741, Department of Economics and Business, Universitat Pompeu Fabra.
    9. Charles M. Harvey & Lars Peter Østerdal, 2010. "Cardinal Scales for Health Evaluation," Decision Analysis, INFORMS, vol. 7(3), pages 256-281, September.
    10. Andrew Briggs, 1995. "Handling Uncertainty in the Results of Economic Evaluation," Briefing 000410, Office of Health Economics.
    11. Anne Spencer, 2000. "Testing the Additive Independence Assumption in the QALY Model," Working Papers 427, Queen Mary University of London, School of Economics and Finance.
    12. Hougaard, Jens Leth & Keiding, Hans, 2005. "On the aggregation of health status measures," Journal of Health Economics, Elsevier, vol. 24(6), pages 1154-1173, November.
    13. Robinson, Ray, 1999. "Limits to rationality: economics, economists and priority setting," Health Policy, Elsevier, vol. 49(1-2), pages 13-26, September.
    14. Bleichrodt, Han, 1997. "Health utility indices and equity considerations," Journal of Health Economics, Elsevier, vol. 16(1), pages 65-91, February.
    15. 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.
    16. Coast, Joanna & Smith, Richard D. & Lorgelly, Paula, 2008. "Welfarism, extra-welfarism and capability: The spread of ideas in health economics," Social Science & Medicine, Elsevier, vol. 67(7), pages 1190-1198, October.
    17. Mark Sculpher, 1998. "The cost‐effectiveness of preference‐based treatment allocation: the case of hysterectomy versus endometrial resection in the treatment of menorrhagia," Health Economics, John Wiley & Sons, Ltd., vol. 7(2), pages 129-142, March.
    18. Magnus Johannesson & Bengt Jönsson & Göran Karlsson, 1996. "Outcome measurement in economic evaluation," Health Economics, John Wiley & Sons, Ltd., vol. 5(4), pages 279-296, July.
    19. Peter P. Wakker & Sylvia J. T. Jansen & Anne M. Stiggelbout, 2004. "Anchor Levels as a New Tool for the Theory and Measurement of Multiattribute Utility," Decision Analysis, INFORMS, vol. 1(4), pages 217-234, December.
    20. Sloan, Frank A. & Kip Viscusi, W. & Chesson, Harrell W. & Conover, Christopher J. & Whetten-Goldstein, Kathryn, 1998. "Alternative approaches to valuing intangible health losses: the evidence for multiple sclerosis1," Journal of Health Economics, Elsevier, vol. 17(4), pages 475-497, August.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:2:y:1993:i:1:p:59-64. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.