Quality-adjusted Life Years, Utility Theory, and Healthy-years Equivalents

Medical Decision Making - Tập 9 Số 2 - Trang 142-149 - 1989
Abraham Mehrez1, Amiram Gafni
1Faculty of Business, McMaster University, Hamilton, Ontario, Canada

Tóm tắt

Decisions about medical treatments and the settings of health programs are not purely technical, but also involve issues of value such as the evaluation of trade-offs between quality of life (morbidity) and quantity of life (mortality). The most commonly used measure of outcome in such cases is the quality-adjusted life year (QALY). The authors show that QALYs, being a health status index, do not stem directly from the individual's utility function and thus only partly reflect the individual's true preferences. This might lead to the choice of the nonpreferred alternative due to the misrepresentation of the individual's preferences. Two examples illustrate this claim. An alternative measure of outcome, the healthy-years equiv alent (HYE), is described. This measure stems directly from the individual's utility function and thus fully reflects his/her preferences. It combines outcomes of both morbidity and mortality and thus can serve as common unit of measure for all programs, allowing com parisons across programs. Different ways of measuring the HYE are discussed. Key words: utility theory; economic evaluation; cost-effectiveness analysis. (Med Decis Making 1989;9:142-149)

Từ khóa


Tài liệu tham khảo

10.4159/harvard.9780674593541

10.1056/NEJM197703312961304

10.1016/0167-6296(86)90020-2

10.1016/0021-9681(87)90019-1

10.1287/opre.30.6.1043

10.1056/NEJM197812212992506

10.1016/0167-6296(83)90005-X

10.1287/opre.28.1.206

10.1177/0272989X8500500208

10.1287/mnsc.22.9.990

10.1177/0272989X8400400411

Churchill DN, 1986, Peritoneal Dialysis Bull., 420

Churchill DN, 1987, Clin Invest Med., 10, 14

Keeney RL, 1976, Decisions with multiple objectives: preferences and value tradeoffs

10.1111/j.1540-5915.1985.tb01682.x

10.1287/mnsc.30.11.1283

10.1287/mnsc.34.2.186

10.1002/mde.4090060315

10.1097/00005650-198406000-00005

10.1038/scientificamerican0182-160

10.1126/science.7455683

10.1177/0272989X8400400108

10.1287/opre.24.5.951

10.1097/00005650-197905000-00005

Torrance GW Multiattribute utility theory as a method of measuring social preferences for health status in long term care In: Kane RL, Kane RA, eds. Values and long-term care. Lexington, MA: Lexington Books, 1982;127-56.

10.1287/mnsc.28.8.936

10.1146/annurev.ps.32.020181.000413

10.1016/0030-5073(80)90071-9

10.1177/0272989X8200200207

10.1016/0038-0121(87)90011-5

Drummond MF, 1987, Torrance GW. Methods for the economic evaluation of health care programes

10.1287/mnsc.30.4.440

Thông tin
Thông tin xuất bản

Medical Decision Making

Tập 9 Số 2

142-149

Thông tin tác giả