| Cost per gained quality
adjusted life years (cost per QALY) has been suggested as
a criterion for prioritizing between different health
care programs. Life years in different states of illness
or dysfunction are assigned values on a scale of 1.0
(healthy) to 0.0 (dead). |
The concept is put into
practice in the health status index approach: life years
in different status index approach. |
| The values reflect the
quality of the states and allow morbidity and mortality
improvements to be combined into a single weighted
measure-that is, QALY’s gained |
For example, if a program
improved the health on individual A from 1-5 to 0-8 for
one year and extends the life of individual B for fine
years in a 0-6 state, then a total of 3-3 QALYs will be
gained (0.8-0.5) + (5.0x0.6) = 3.3). |
| Cost per QALYs gained (the
so called "cost:utility ratio") may be
calculated for different programmes. |
Economist recommendation is
to rank the health issues from the lowest cost per QALY
value to the highest and to select from the top until
available resources are exhausted. |
| The health status index
approach and the focusing on life years as units of
measurement are main causes of public resentment against
QALYs |
The core of the QALY
procedure, however, is not to value health improvements
but rather to value health states. |
| Assigning a value to life
itself according to the health state of the individual
concerned |
A life in a wheelchair is
considered not only less healthy than a life without
disability but also of less value. |
| This position is ethically
highly controversial |
Disabled people find it
repugnant. |
| Emphasis on the size of a
health improvement and disregards that starting point and
end point. |
Small but significant
improvement for a person in a bad state may be preferred
by society to a more substantial improvement for a person
in a less severe state. |
| Problematic basic feature of
the QALY procedure is its focus on quality of life in
life years rather than quality of life in person's daily
function. |
And the general public
providing care for living, breathing, feeling, and
thinking individuals, not with maximizing numbers of
abstract time |
| Simpler and more
straightforward solution |
Choose one particular health
care outcome as the unit of measurement and let people
compare other outcomes directly with this unit |
| Saving the life of a young
person and restoring him or her to full health. |
Most people will probably
regard it as the maximum benefit that a single individual
can obtain. |
| Allocating scarce resources
to different areas of health care interventions with an
expected outcome of 1 SAVE: should have priority |
SAVE procedure is suggested
as an aid to decision making |
| Should not replace critical
thought and responsible discussion |
The SAVE procedure, the
amount of health produced by intervention but also of any
distributional or ethical consideration they |
| Society may find that the
two kinds of patients should have equal priority on the
grounds that both would be significantly helped and both
are equally entitled to treatment. |
Ethical rules will often
apply in this context-in particular the obligation to
save human life almost regardless of cost (the"rule
or rescue") |
| "the amount of
health" produced by different health services of
different therapies |
For this the QALY may be a
useful concept. |
Main advantages with SAVEs
- Yield social values for health gains for
individuals in more direct manner
- Incorporate various distributional rules
- Use easily understandable unit of
measurement-namely, value of saving a young life
|
Perceived drawbacks with
QALYs
- Quality of life per se expressed in terms of
numbers
- Value assigned to life varies with health state
of person
- All emphasis placed on size of health
improvement, ignoring starting point
- Focus on quality of life in life years rather
than on quality of life in people
|
