Severity of illness versus expected benefit in societal evaluation of healthcare interventions

Society's valuation of a healthcare outcome depends not only on the size of the gain in well-being (utility), but also on the severity of the initial condition. This seems to be a major problem with the conventional utility-based QALY approach to outcome evaluation. In particular, QALY calculations based on utilities from multiattribute utility instruments assign too high value to interventions for people with mild and moderate health problems compared with interventions for people with severe and life threatening diseases. Analysts should somehow make corrections for this bias in economic evaluations of healthcare programs.