QALY maximisation and people's preferences: a methodological review of the literature
Tóm tắt
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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Tài liệu tham khảo
Hartley RJ, 1990, Online Searching: Principles and Practice
Ubel PA, 1998, Public preferences for prevention versus cure: what if an ounce of prevention is worth only an ounce of cure?, Med Decision Making, 18, 141, 10.1177/0272989X9801800202
Ubel PA, 1999, Life‐saving treatments and disabilities—are all QALYs created equal?, Int J Technol Assess Health Care, 15, 738, 10.1017/S0266462399154138
Williams A, 1988, Philosophy and Medical Welfare
Kneeshaw J, 1999, Rationing: Talking and Action in Health Care
Furnham A, 2000, Decisions concerning the allocation of scarce medical resources, J Social Behav Personality, 15, 185
Dolan P, 2003, Individual Choice and the Social Welfare Function: Some Theoretical Issues and Empirical Evidence from Health
EdwardsRT BolandA WilkinsonC CohenD WilliamsJ.Choosing explicit criteria for the prioritisation of elective NHS waiting lists: survey evidence of clinical and lay preferences from Wales. In Proceedings of the Health Economists' Study Group Meeting Birmingham 1999.
Dolan P, 2002, Determining the parameters in a social welfare function using stated preference data: an application to health
Ubel PA, 1996, Public preferences for efficiency and racial equity in kidney transplant allocation decisions, Transplant Proc, 28, 2997
Wagstaff A, Cost–Benefit Analysis
Choudhry N, 1997, Distributional dilemmas in health policy: large benefits for a few or smaller benefits for many?, J Health Serv Res Policy, 2, 212, 10.1177/135581969700200405