"Quality-Adjusted Life Year" from Wikipedia

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There is no suggested book to read for this month.

However for extra credit, you can skim the last four items posted in this section (they were posted as "replies" to Bill's proposal by two of our participants before Bill’s proposal was adopted) -

(1) An Op-Ed Article by the CEO of Safeway Inc. describing how they have lowered their health-care costs by 38% by charging employees for the extra actuarial cost of smoking and obesity (which is reminiscent of the "U.K. Fat Tax" Proposal by Oxford University posted on our web site for our discussion 24 months ago);

(2) An Op-Ed Article by a Wharton Professor of Health-Care Management and Insurance/Risk Management about incenting good behavior in general;

(3) A Washington Post news report on the July 16 Congressional Budget Office Report on how none of the health-care bills in Congress control costs - touching off the firestorm of opposition that is still raging; and

(4) Utah Owl's recommended web sites for info about the issue.

Also of pivotal interest in understanding the debate about so-called “death panels” is the Wikipedia article on “Quality-Adjusted Life Years” (or “QALY”) which explains how insurance policies (both employer-provided and individual policies) determine what procedures will be covered. And the article by Harvard Econ Prof Marty Feldstein (former Chair of the President’s Council of Economic Advisers) mentions, among other interesting points, that Britain’s National Health Service will only cover procedures that cost less than £ 30,000 (or $49,685) per QALY. It should be noted that so-called “gold-plated” employer-provided health-insurance plans range as high as $500,000 per QALY.

And for anyone interested in additional background material to supplement current news reports, there is quite a bit of interesting material posted on this bulletin board for the last two times we discussed health care - 24 months ago and 5 months ago.

THERE IS A GOOD CHANCE OUR DISCUSSION WILL RESULT IN ONE OF OUR "SIX DEGREES OF SEPARATION" APPEALS FOR EVERYONE TO E-MAIL PRESIDENT OBAMA WITH RESPECT TO A PARTICULAR OPPORTUNITY, AND FOR EVERYONE TO REQUEST THEIR FRIENDS AND ACQUAINTANCES TO DO THE SAME IN AN UNENDING CHAIN.
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"Quality-Adjusted Life Year" from Wikipedia

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Quality-adjusted life year
From Wikipedia, the free encyclopedia

The quality-adjusted life year (QALY) is a measure of disease burden, including both the quality and the quantity of life lived[1][2][3]. It is used in assessing the value for money of a medical intervention. The QALY model requires utility independent, risk neutral, and constant proportional tradeoff behaviour[4].

The QALY is based on the number of years of life that would be added by the intervention. Each year in perfect health is assigned the value of 1.0 down to a value of 0.0 for death. If the extra years would not be lived in full health, for example if the patient would lose a limb, or be blind or be confined to a wheelchair, then the extra life-years are given a value between 0 and 1 to account for this.

Use

The QALY is used in cost-utility analysis to calculate the ratio of cost to QALYs saved for a particular health care intervention. This is then used to allocate healthcare resources, with an intervention with a lower cost to QALY saved ratio being preferred over an intervention with a higher ratio. This method is controversial because it means that some people will not receive treatment as it is calculated that cost of the intervention is not warranted by the benefit to their quality of life. However, its supporters argue that since health care resources are inevitably limited, this method enables them to be allocated in the way that is most beneficial to society instead of most beneficial to the patient.

Meaning

The meaning and usefulness of the QALY is debated[5][6][7]. Perfect health is hard, if not impossible, to define. Some argue that there are health states worse than death, and that therefore there should be negative values possible on the health spectrum (indeed, some health economists have incorporated negative values into calculations). Determining the level of health depends on measures that some argue place disproportionate importance on physical pain or disability over mental health. The effects of a patient's health on the quality of life of others (e.g. caregivers or family) do not figure into these calculations.

Weighting
The "weight" values between 0 and 1 are usually determined by methods such as:

· Time-trade-off (TTO) - In this method, respondents are asked to choose between remaining in a state of ill health for a period of time, or being restored to perfect health but having a shorter life expectancy.

· Standard gamble (SG) - In this method, respondents are asked to choose between remaining in a state of ill health for a period of time, or choosing a medical intervention which has a chance of either restoring them to perfect health, or killing them.

· Visual analogue scale (VAS) - In this method, respondents are asked to rate a state of ill health on a scale from 0 to 100, with 0 representing death and 100 representing perfect health. This method has the advantage of being the easiest to ask, but is the most subjective.

Another way of determining the weight associated with a particular health state is to use standard descriptive systems such as the EuroQol Group's EQ-5D questionnaire, which categorises health states according to the following dimensions: mobility, self-care, usual activities (e.g. work, study, homework or leisure activities), pain/discomfort and anxiety/depression.

However, the weight assigned to a particular condition can vary greatly, depending on the population being surveyed. Those who do not suffer from the affliction in question will, on average, overestimate the detrimental effect on quality of life, compared to those who are afflicted.

References

1. ^ National Institute for Health and Clinical Excellence - Measuring effectiveness and cost effectiveness: the QALY
2. ^ "What is a QALY?" (pdf). Hayward Medical Communications. http://www.evidence-based-medicine.co.u ... saQALY.pdf. Retrieved 2008-11-14.
3. ^ Bandolier - QALY
4. ^ [|Pliskin, Joseph]; Shepard, D; Weinstein, M (1980). "Utility Functions for Life Years and Health Status". Operations Research (Operations Research Society of America) 28 (1): 206-224. http://www.jstor.org/pss/172147. Retrieved 2008-11-13.
5. ^ Prieto, Luis; Sacristán, JA (2003-12-19). "Problems and solutions in calculating quality-adjusted life years (QALYs)" (pdf). Health and Quality of Life Outcomes (BioMed Central) 1. doi:10.1186/1477-7525-1-80. http://www.hqlo.com/content/1/1/80. Retrieved 2008-11-14.
6. ^ Schlander, Michael (2007-07-09). "Lost in Translation? Over-Reliance on QALYs May Lead to Neglect of Relevant Evidence". Copenhagen, Denmark: Institute for Innovation & Valuation in Health Care.
7. ^ Mortimer, Duncan; Segal, L (2008). "Comparing the Incomparable? A Systematic Review of Competing Techniques for Converting Descriptive Measures of Health Status into QALY-Weights" (pdf). Medical Decision Making (SAGE Publications) 28 (1): 66-89. doi:10.1177/0272989X07309642. http://mdm.sagepub.com/cgi/content/abstract/28/1/66. Retrieved 2008-11-14.

See also

· Case mix index
· Cost-Effectiveness Analysis Registry
· Cost-utility analysis
· Disability-adjusted life year (DALY)
· National Institute for Health and Clinical Excellence (United Kingdom)
· Quality of life and measurements such as MANSA and Life Quality Index

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