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Measuring the Subjective Value of Risky and Ambiguous Options using Experimental Economics and Functional MRI Methods
Published on: September 19, 2012
Improving value measurement in cost-effectiveness analysis.
1Veterans Affairs Medical Center and Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA.
Medical Care
|September 12, 2000
Summary
Cost-effectiveness analysis (CEA) needs to incorporate societal values to guide healthcare decisions. Moving beyond quality-adjusted life years (QALYs) can help escape the "QALY trap" and better reflect fairness preferences.
Area of Science:
- Health economics
- Public health policy
- Bioethics
Background:
- Cost-effectiveness analysis (CEA) is a tool for healthcare allocation.
- Current CEA methods, using quality-adjusted life years (QALYs), may not fully capture societal values.
- Societal preferences for fairness and equity are not adequately incorporated into traditional CEA.
Purpose of the Study:
- To identify limitations in current cost-effectiveness analysis (CEA) methods.
- To explore how societal values can be better integrated into CEA.
- To propose an alternative approach to CEA that moves beyond the limitations of QALYs.
Main Methods:
- Declarative exposition of theoretical fallacies in CEA.
- Discussion of societal values not currently incorporated into CEA, such as prioritizing severely ill patients and avoiding discrimination.
- Analysis of the
- QALY trap
- and its implications for individuals with disabilities or chronic illnesses.
Main Results:
- Traditional CEA, relying on QALYs, can lead to counterintuitive conclusions, such as undervaluing treatments for conditions like paraplegia.
- Current QALY-based methods may fail to recognize the benefit of curing conditions that do not extend life expectancy but improve quality of life.
- Societal values regarding fairness and equity are not accurately reflected in QALY measurements.
Conclusions:
- Amending CEA methodology to incorporate a wider range of societal values is necessary.
- Basing cost-effectiveness measurements on societal values, rather than solely on QALYs, can better capture public preferences for rationing.
- This approach can help escape the
- QALY trap
- and lead to more equitable healthcare allocation decisions.
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