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

Health Economics (United Kingdom) - Tập 14 Số 2 - Trang 197-208 - 2005
Paul Dolan1,2, Rebecca Shaw3, Aki Tsuchiya4, Alan Williams5
1Health Economics Research Programme, University of Oslo, Norway
2Sheffield Health Economics Group, School of Health and Related Research, University of Sheffield, UK
3Department of Sociology, University of York, UK
4Sheffield Health Economics Group, University of Sheffield, UK
5Centre for Health Economics, University of York, UK

Tóm tắt

AbstractIn 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

10.3310/hta5030

10.1136/jme.17.4.185

10.1016/S0167-6296(97)00010-6

10.1016/0168-8510(93)90042-N

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

10.1016/S0168-8510(99)00043-3

10.1177/0272989X9501500302

10.1016/S0167-6296(97)00022-2

10.1016/S0277-9536(99)00174-4

10.1016/0168-8510(95)00714-4

10.1016/0277-9536(95)00216-2

10.1177/0272989X9601600307

Ubel PA, 1999, Life‐saving treatments and disabilities—are all QALYs created equal?, Int J Technol Assess Health Care, 15, 738, 10.1017/S0266462399154138

10.1002/(SICI)1099-1050(199912)8:8<701::AID-HEC473>3.0.CO;2-M

10.1136/jme.19.1.37

10.1002/(SICI)1099-1050(199902)8:1<25::AID-HEC398>3.0.CO;2-H

10.1046/j.1369-6513.1999.00061.x

10.1002/(SICI)1099-1050(199806)7:4<307::AID-HEC345>3.0.CO;2-N

10.1016/S0168-8510(99)00079-2

10.1016/S0277-9536(99)00120-3

10.1016/S0277-9536(98)00343-8

10.1111/j.1467-8519.1992.tb00208.x

10.1002/(SICI)1099-1050(199703)6:2<117::AID-HEC256>3.0.CO;2-B

10.1111/j.1467-8519.1994.tb00242.x

10.1016/S0167-6296(97)00004-0

10.1111/1468-0335.00224

10.1177/089826439500700207

10.1093/geront/33.1.74

10.1136/bmj.312.7032.670

10.1016/0277-9536(93)90451-9

10.1016/0277-9536(89)90352-3

10.1007/BF02197680

10.1002/1099-1050(200010)9:7<611::AID-HEC540>3.0.CO;2-R

Tsuchiya A, 2001, The value of health at different ages, 10.7748/nm.8.2.39.s19

Williams A, 1988, Philosophy and Medical Welfare

10.1016/S0277-9536(00)00187-8

10.1007/BF01064044

10.1016/S0168-8510(96)90022-6

10.1016/S0167-6296(96)00516-4

10.1136/jme.15.1.28

10.1016/0277-9536(95)00121-M

10.1007/BF02251210

10.1016/S0277-9536(98)00012-4

10.1007/BF01047663

10.1016/S0167-6296(01)00095-9

10.1016/0167-6296(92)90003-J

10.1002/(SICI)1099-1050(200003)9:2<137::AID-HEC489>3.0.CO;2-1

Kneeshaw J, 1999, Rationing: Talking and Action in Health Care

10.1016/0022-1031(92)90043-J

10.1136/bmj.317.7152.172

10.1111/1467-8519.00131

10.1053/jlts.2001.25361

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

10.1136/bmj.318.7188.916

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.

10.1177/0272989X9701700102

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

10.1016/S0277-9536(00)00267-7

10.1016/0167-6296(93)90004-X

Wagstaff A, Cost–Benefit Analysis

10.1002/hec.646

10.1002/(SICI)1099-1050(1998110)7:7<621::AID-HEC370>3.0.CO;2-Y

10.1016/0168-8510(95)00783-0

10.1093/eurpub/9.2.124

10.1093/eurpub/7.4.405

10.1136/jech.52.12.808

10.1002/(SICI)1099-1050(199908)8:5<369::AID-HEC456>3.0.CO;2-Q

10.1016/0167-6296(96)00005-7

10.1016/S0014-2921(00)00052-0

10.1002/hec.590

10.1016/S0167-6296(00)00035-7

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

10.1002/hec.4730030106

10.1002/hec.643

10.1056/NEJM199605023341807

10.1097/00005650-200004000-00003

10.1016/S0277-9536(02)00418-5

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Health Economics (United Kingdom)

Tập 14 Số 2

197-208

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