Health utility indices and equity considerations

The aim of this paper is to propose methods that incorporate equity concerns into cost utility analysis. The focus of the paper is on QALYs, but the results apply to health utility indices in general. Two interpretations of QALYs are considered: QALYs as (von Neumann Morgenstern) utilities and QALYs as measures of health. A justification is provided for aggregating consistently scaled "QALYs as utilities" over individuals. The conditions underlying unweighted aggregation of QALYs are identified. These conditions exclude two common types of equity concern. Algorithms are proposed that take into account equity concerns and that are relatively easy to apply.