Improving value measurement in cost-effectiveness analysis.
Journal Article (Journal Article)
Objective
Before cost-effectiveness analysis (CEA) can fulfill its promise as a tool to guide health care allocation decisions, the method of incorporating societal values into CEA may need to be improved.Design
The study design was a declarative exposition of potential fallacies in the theoretical underpinnings of CEA. Two values held by many people-preferences for giving priority to severely ill patients and preferences to avoid discrimination against people who have limited treatment potential because of disability or chronic illness-that are not currently incorporated into CEA are discussed.Conclusions
Traditional CEA, through the measurement of quality-adjusted life years (QALYs), is constrained because of a "QALY trap." If, for example, saving the life of a person with paraplegia is equally valuable as saving the life of a person without paraplegia, then current QALY methods force us to conclude that curing paraplegia brings no benefit. Basing cost-effectiveness measurement on societal values rather than QALYs may allow us to better capture public rationing preferences, thereby escaping the QALY trap. CEA can accommodate a wider range of such societal values about fairness in its measurements by amending its methodology.Full Text
Duke Authors
Cited Authors
- Ubel, PA; Nord, E; Gold, M; Menzel, P; Prades, JL; Richardson, J
Published Date
- September 2000
Published In
Volume / Issue
- 38 / 9
Start / End Page
- 892 - 901
PubMed ID
- 10982111
Pubmed Central ID
- 10982111
Electronic International Standard Serial Number (EISSN)
- 1537-1948
International Standard Serial Number (ISSN)
- 0025-7079
Digital Object Identifier (DOI)
- 10.1097/00005650-200009000-00003
Language
- eng