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The qaly—a measure of social value rather than individual utility?

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  • Erik Nord

Abstract

The paper examines different interpretations of the QALY concept. It is suggested that the QALY interpreted as a measure of amounts of well‐life does not carry sufficient empirical meaning. As a measure of individuals' personal appreciation of outcomes in their own lives the QALY does not seem to work in comparisons of life saving interventions with interventions that improve health or increase life expectancy. For the QALY to be a generally empirically meaningful concept, it looks as though it needs to be interpreted as a measure of social value. This conclusion has direct implications for how values for health states should be elicited.

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  • 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.
    • Handle: RePEc:wly:hlthec:v:3:y:1994:i:2:p:89-93
    DOI: 10.1002/hec.4730030205
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    1. 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.
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    Cited by:

    1. Johansson-Stenman, Olof & Martinsson, Peter, 2008. "Are some lives more valuable? An ethical preferences approach," Journal of Health Economics, Elsevier, vol. 27(3), pages 739-752, May.
    2. 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.
    3. 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.
    4. Hoel, Michael, 2007. "What should (public) health insurance cover?," Journal of Health Economics, Elsevier, vol. 26(2), pages 251-262, March.
    5. Bleichrodt, Han, 1997. "Health utility indices and equity considerations," Journal of Health Economics, Elsevier, vol. 16(1), pages 65-91, February.
    6. Bleichrodt, Han & Johannesson, Magnus, 1997. "Standard gamble, time trade-off and rating scale: Experimental results on the ranking properties of QALYs," Journal of Health Economics, Elsevier, vol. 16(2), pages 155-175, April.
    7. Tosin Lambe & Emma Frew & Natalie J. Ives & Rebecca L. Woolley & Carole Cummins & Elizabeth A. Brettell & Emma N. Barsoum & Nicholas J. A. Webb, 2018. "Mapping the Paediatric Quality of Life Inventory (PedsQL™) Generic Core Scales onto the Child Health Utility Index–9 Dimension (CHU-9D) Score for Economic Evaluation in Children," PharmacoEconomics, Springer, vol. 36(4), pages 451-465, April.
    8. Dolan, Paul, 1998. "The measurement of individual utility and social welfare," Journal of Health Economics, Elsevier, vol. 17(1), pages 39-52, January.
    9. Pinkerton, Steven D. & Johnson-Masotti, Ana P. & Derse, Arthur & Layde, Peter M., 2002. "Ethical issues in cost-effectiveness analysis," Evaluation and Program Planning, Elsevier, vol. 25(1), pages 71-83, February.
    10. Shiell, Alan, 1997. "Health outcomes are about choices and values: an economic perspective on the health outcomes movement," Health Policy, Elsevier, vol. 39(1), pages 5-15, January.
    11. Michael Hoel, 2003. "Allocating health care resources when people are risk averse with respect to life time," Health Economics, John Wiley & Sons, Ltd., vol. 12(7), pages 601-608, July.
    12. 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.
    13. Erik Nord, 1995. "The Person-trade-off Approach to Valuing Health Care Programs," Medical Decision Making, , vol. 15(3), pages 201-208, August.
    14. Gyrd-Hansen, Dorte, 2004. "Investigating the social value of health changes," Journal of Health Economics, Elsevier, vol. 23(6), pages 1101-1116, November.
    15. Lars Peter Østerdal, 2004. "QALYs, Person Trade-Offs, and the Pareto Principle," Discussion Papers 04-10, University of Copenhagen. Department of Economics.
    16. Juan Manuel Cabasés & Idoia Gaminde & José M. Ugalde, 2000. "Societal perspective on the eliciting of health states preferences," Documentos de Trabajo - Lan Gaiak Departamento de Economía - Universidad Pública de Navarra 0010, Departamento de Economía - Universidad Pública de Navarra.
    17. John Hutton, 2012. "‘Health Economics’ and the evolution of economic evaluation of health technologies," Health Economics, John Wiley & Sons, Ltd., vol. 21(1), pages 13-18, January.
    18. Hoel, Michael, 2009. "Efficient use of health care resources: The interaction between improved health and reduced health related income loss," HERO Online Working Paper Series 2001:9, University of Oslo, Health Economics Research Programme.
    19. 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.

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