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Related Experiment Videos

Against lifetime QALY prioritarianism.

Anders Herlitz1,2

  • 1Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden.

Journal of Medical Ethics
|October 11, 2017
PubMed
Summary

Lifetime quality-adjusted life-year (QALY) prioritarianism is challenged for its reliance on questionable assumptions about health distributions. This approach may inaccurately identify who is worse off, impacting health priority setting.

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Area of Science:

  • Health Economics
  • Ethics
  • Public Health Policy

Background:

  • Prioritarianism in health economics prioritizes benefits for the worse off.
  • Lifetime quality-adjusted life-year (QALY) is a common metric for health gains.
  • Lifetime QALY prioritarianism has been proposed as a way to apply prioritarian principles.

Purpose of the Study:

  • To critically evaluate lifetime QALY prioritarianism.
  • To identify and challenge the underlying assumptions of this approach.
  • To propose alternative considerations for identifying who is worse off in health priority setting.

Main Methods:

  • Philosophical argumentation and conceptual analysis.
  • Examination of the assumptions of strict additivity, atomism, and intertemporal separability in lifetime QALY calculations.
Keywords:
allocation of health care resourcesdistributive justicehealth care economicshealth economicspolitical philosophy

Related Experiment Videos

  • Critique of how these assumptions affect the assessment of well-being and disadvantage.

    • Main Results:

    • Lifetime QALY prioritarianism rests on implausible assumptions.
    • These assumptions lead to a disregard for both intrapersonal and interpersonal distributions of health states.
    • The metric fails to adequately capture who is truly worse off.

    Conclusions:

    • Lifetime QALY prioritarianism should be rejected.
    • Prioritarians must consider intrapersonal and interpersonal distributions when assessing disadvantage.
    • Alternative frameworks are needed for equitable health priority setting.