Unbiased Analysis of Today's Healthcare Issues
The term “Carer QALY” was coined in a paper by Mott et al. (2023) and is identified as the case where “it is possible for an effective treatment that provides survival gains (with relatively little or no QOL gain) to appear less effective than the comparators when carer QOL is considered.” While the term “Carer…
One concern when using quality adjusted life years (QALY) to measure health gains for cost effectiveness research is that QALYs “undervalue” health gains from life extension for people with serious illness or chronic disability. To see this clearly, take a look at the QALY formula (first formula below) and how it can be decomposed into…
That is the topic of a Health Affairs Forefront article (Sullivan et al. 2021) out today which is addresses the topic. The issue is particularly relevant as the Inflation Reduction Act (IRA)’s has a de facto ban on QALYs for use in setting a drug’s maximum fair price (MFP). The authors discuss some alternatives: The…
A paper by Rand and Kesselheim (2021) in Health Affairs this month conducts a systematic literature review to answer this question. Based on 113 articles they identified in peer-reviewed journals, they identify the following 10 criticisms categories. The graph above has each criticism category and the number of peer-reviewed articles that mention this critique type.…
Standard cost-effectiveness analysis assumes that any gain in quality-adjusted life years (QALYs) should be valued equally. This does not sound unreasonable, but is it true in practice? Consider two potential violations of constant value of QALY gains: scope insensitivity and severity independence. I define each of these below: Scope insensitivity. This assumes that individuals value…
How much should we value life? This is the question put forth in an interesting book by Howard Steven Friedman called Ultimate Price. The book reviews how economists, policymakers, philosophers and others place a monetary value on life. This could be a value courts place when making awards in lawsuits due to harm or death,…
Many health economists rely on the concept of a quality-adjusted life year (QALY) to measure the value of different treatments. When comparing one treatment to another, one can summarize the health benefits based on not only the among of life that was extended (i.e., extra years lived) but also what the quality of life is. …
Defining which cancer treatments are the “best” is not as easy as you think. At first glance, treatments that produce the largest survival gains should be considered best. Most cancer treatments come with serious side effects. Thus, new treatments that better improve survival may also increase the risk of adverse events (although in some cases–like…
The hedonic treadmill is a concept that people acclimate to changes in their life and improvements in quality of life. For instance, people who buy a new car have a brief short-term burst of happiness, but after people acclimate to having the car, their quality of life returns to the previous level. This concept can be…
Alan Balch, PhD, discusses the Institute for Clinical and Economic Review’s (ICER’s) Value Assessment Framework tool that aims to provide stakeholders in healthcare with evidence to make more informed decisions regarding new cancer therapies. Dr Balch also considers limitations to the tool’s effectiveness. Plus, he even discusses why if we lived life using a strict…