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Related Experiment Videos

Double discounting of QALYs.

Linda D MacKeigan1, Amiram Gafni, Bernie J O'Brien

  • 1Faculty of Pharmacy, University of Toronto, Toronto, Canada. l.mackeigan@utoronto.ca

Health Economics
|February 4, 2003
PubMed
Summary

Double discounting occurs when applying standard discount rates to quality-adjusted life-years (QALYs) derived from time tradeoff (TTO) preferences. This study investigated the extent of this effect and methods to avoid it in TTO-based QALY models.

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Area of Science:

  • Health Economics
  • Decision Analysis
  • Pharmacoeconomics

Background:

  • Quality-adjusted life-years (QALYs) are a standard outcome measure in health technology assessment.
  • Time tradeoff (TTO) methods for eliciting preferences for health states incorporate an implicit time discount rate.
  • Applying an external discount rate to TTO-based QALYs can lead to 'double discounting'.

Purpose of the Study:

  • To quantify the magnitude of the double discounting effect in TTO-based QALY models.
  • To evaluate the effectiveness of a proposed method for mitigating double discounting.
  • To understand the implications for economic evaluations in type 2 diabetes.

Main Methods:

  • Utilized holistic and composite preference scores from a prior TTO study.
  • Analyzed four hypothetical treatment pathways for type 2 diabetes.
  • Assessed discrepancies between discounted composite and holistic preference scores.
  • Evaluated adjustments to TTO-based quality weights before external discounting.

Main Results:

  • Significant discrepancies were observed between discounted composite and holistic preference scores.
  • Adjusting TTO-based quality weights prior to external discounting yielded only a minor reduction in discrepancies.
  • The double discounting effect demonstrated a notable impact on QALY calculations.

Conclusions:

  • The double discounting effect presents a challenge for accurate economic evaluations using TTO-based QALYs.
  • Current methods for avoiding double discounting may be insufficient.
  • Further research is needed to investigate context-dependent time preference effects in health states.

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