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PharmacoEconomics

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01-01-2008 | Editorial

The New Myth

The Social Value of the QALY

Authors: Dr Werner Brouwer, Job van Exel, Rachel Baker, Cam Donaldson

Published in: PharmacoEconomics | Issue 1/2008

Excerpt

Throughout history there have always been people who are susceptible to myths and have tried to find the unfindable, whether it be the Holy Grail providing eternal life for its finder, the alchemic formula turning lead into gold, Bigfoot or the pot of gold at the end of the rainbow. These myths come in different forms; some are clearly placed in a religious or metaphysical context (e.g. the Holy Grail), while others are marketed with an earthly and scientific aura (e.g. the hairs of Bigfoot). …

The very brave sometimes even attempt to assist in the optimal allocation of resources across (public) sectors.

Although there is some international variation (e.g. especially slight differences in terms of which sacrifices — called costs — should be considered in the ritual and how), the basic ritual is the same in all branches of the tribe.

Although it needs to be noted that a small group of persistent dissidents within the tribe have questioned the Ratio as highest knowledge, and have advocated other convictions regarding how to come to optimal allocations (for example, see Gafni and Birch[1]).

For example, the session on the social value of a QALY during the iHEA conference in Copenhagen.[2]

For example, see Gravelle et al.[4] and references therein.

Indeed, it has even been argued that current thresholds may be too high (e.g. Williams[8]).

For instance, Hammond[11] argued that most existing approaches to interpersonal comparisons of utility — both theoretical and empirical — are flawed by failing ‘to be recognised for what they really are — preferences for different kinds of people’.

Productivity costs can be calculated separately, which seems more appropriate if to be included. Moreover, the well-being effects in dependents might also be captured directly rather than indirectly.

The arguments above already implicitly addressed this issue, e.g. a drunk driver may highly value his/her own QALY gains (even more so than the person he/she hit) but society may judge differently.

See Smith and Richardson[12] for an excellent discussion.

Gafni A, Birch S. Incremental cost effectiveness ratios (ICERs): the silence of the lambda. Sec Sci Med 2006; 62: 2091–2100CrossRef

6th iHEA World Congress; 2007 Jul 8–11; Copenhagen

Boadway R, Bruce N. Welfare economics. Oxford: Basil Backwell, 1984

Gravelle H, Brouwer WBF, Niessen LW, et al. Discounting in economic evaluations: stepping forward towards optimal decision rules. Health Econ 2007; 16 (3): 307–317PubMedCrossRef

Hirth RA, Chernew ME, Miller E, et al. Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making 2000; 20 (3): 332–342PubMedCrossRef

Taylor RS, Drummond MF, Salkeld G, et al. Inclusion of cost effectiveness in licensing requirements of new drugs: the fourth hurdle. BMJ 2004 Oct 23; 329 (7472): 972–975PubMedCrossRef

Dranove D. What’s your life worth? New York: FT Prentice Hall, 2003

Williams A. What could be nicer than NICE? OHE Annual Lecture 2004. London: Office of Health Economics, 2004

Williams A. Intergenerational equity: an exploration of the fair innings argument. Health Econ 1997; 6 (2): 117–132PubMedCrossRef

10.

Stolk EA, van Donselaar G, Brouwer WBF, et al. Reconciliation of economic concerns and health policy: illustration of an equity adjustment procedure using proportional shortfall. Pharmacoeconomics 2004; 22 (17): 1097–1107PubMedCrossRef

11.

Hammond PJ. Interpersonal comparisons of utility: why and how they are and should be made. In: Elster J, Roemer JE, editors. Interpersonal comparisons of well-being. Cambridge (MA): Cambridge University Press, 1991

12.

Smith R, Richardson J. Can we estimate the ‘social’ value of a QALY? Four core issues to resolve. Health Policy 2005; 74 (1): 77–84PubMedCrossRef

13.

Bleichrodt H, Quiggin J. Life cycle preferences over consumption and health: when is cost effectiveness analysis equivalent to cost benefit analysis? J Health Econ 1999; 18: 681–708PubMedCrossRef

14.

Williams A, Cookson R. Equity in health. In: Culyer AJ, Newhouse JP, editors. Handbook of health economics. Amstere, 2000

15.

European Value of a Quality Adjusted Life Year [online]. Available from URL: http://research.ncl.ac.uk/eurovaq [Accessed 2007 Dec 06]

Title: The New Myth
The Social Value of the QALY
Authors: Dr Werner Brouwer
Job van Exel
Rachel Baker
Cam Donaldson
Publication date: 01-01-2008
Publisher: Springer International Publishing
Published in: PharmacoEconomics / Issue 1/2008
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI: https://doi.org/10.2165/00019053-200826010-00001

At a glance: The STEP trials

Springer Medicine

The New Myth

The Social Value of the QALY

Excerpt

At a glance: The STEP trials

Springer Medicine

Excerpt

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