[QALYs and fairness: health economic approaches to the fairness issue and their problems]

Empirical studies have shown that QALY-maximization leads to results that are perceived as unfair. Health economists have attempted to integrate fairness aspects in Cost-Utility Analysis by means of equity weighting. A well-known example is Cost-Value Analysis (Nord et al.). Over and above the value of individual health related utilities, it tries to capture the value of distributing resources fairly. The debate has shown, however, that these approaches face several problems. The present contribution argues that the difficulties are of a more fundamental nature than most contributors to the debate have hitherto assumed. Cost-utility analysis, we believe, cannot consistently be adjusted to meet fairness objections by means of weighting schemes.