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The Quality Adjusted Life Year: A Total-Utility Perspective

Published online by Cambridge University Press:  06 March 2018

STEVEN J. FIRTH
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Abstract:

Given that a properly formed utilitarian response to healthcare distribution issues should evaluate cost effectiveness against the total utility increase, it follows that any utilitarian cost-effectiveness metric should be sensitive to increases in both individual and social utility afforded by a given intervention. Quality adjusted life year (QALY) based decisionmaking in healthcare cannot track increases in social utility, and as a result, the QALY cannot be considered a strict utilitarian response to issues of healthcare distribution. This article considers arguments against, and a possible defence of, the QALY as a utilitarian concept; in response, the article offers a similar — but properly formed — utilitarian metric called the (IALY). This article also advances a tool called the ‘glee factor’ (GF) on which the IALY may lean in a similar way to which the QALY leans on the Rosser Index.

Keywords

QALYIALYutilitarianismwelfare distributionsocial and political theoryhealthcare distributionglee factorhealthcare ethicshealth economicssocial utility
Type
Special Section: Justice, Healthcare, and Wellness
Information
Cambridge Quarterly of Healthcare Ethics , Volume 27 , Issue 2 , April 2018 , pp. 284 - 294
Copyright
Copyright © Cambridge University Press 2018 

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References

Notes

1. For example: Dolan, P. Utilitarianism and the measurement and aggregation of quality – adjusted life years. Health Care Analysis 2001(9):65;CrossRefGoogle ScholarPubMed Schwartz, S, Richardson, J, Glasziou, PP. Quality-adjusted life years: Origins, measurements, applications, objections. Australian Journal of Public Health 2010;17(3):276.CrossRefGoogle Scholar

2. Williams, A. The value of QALYs. In: Holland, S, ed. Arguing about Bioethics. New York: Routledge; 2012, at 423.Google Scholar

3. See note 2, Williams 2012, at 423.

4. Prieto L, Sacristán J. Problems and solutions in calculating quality-adjusted life years (QALYs). Health and Quality of Life Outcomes BioMed Central. 1(80), 2003; available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC317370/ (last accessed March 2016).

5. See note 4, Prieto, Sacristán 2003.

6. See note 4, Prieto, Sacristán 2003.

7. Weinstein, M, Torrance, CG, Mcguire, A. QALYs: The basics. Value in Health 2009;12(1):S5–S5, at S5.CrossRefGoogle ScholarPubMed McGregor, M, Caro, JJ. QALYs: Are they helpful to decision makers. Current Opinion: Pharmacoeconomics 2006;24(10):947;Google ScholarPubMed Dolan, P. Utilitarianism and the measurement and aggregation of quality-adjusted life years. Health Care Analysis. 2001;9:65–76.CrossRefGoogle ScholarPubMed

8. See note 7, Weinstein et al. 2009.

9. See note 7, McGregor, Caro 2006.

10. See, for example, note 4, Prieto, Sacristán 2003.

11. Soares, MO. Is the QALY blind, deaf and dumb to equity? NICE’s considerations over equity. British Medical Bulletin 2012;101:18.CrossRefGoogle ScholarPubMed

12. Schwartz, S, Richardson, J, Glasziou, PP. Quality-adjusted life years: Origins, measurements, applications, objections. Australian Journal of Public Health 2010;17(3):276.CrossRefGoogle Scholar

13. See note 12, Schwartz et al. 2010.

14. See note 12, Schwartz et al. 2010.

15. See, for example, Bobinaca, A, Job, N, Van Exel, A, Rutten, FFH, Brouwer, WBF. Valuing QALY gains by applying a societal perspective. Health Economics. 2012;2:1272–81;Google Scholar Pinto, PJL, Loomes, G, Brey, R. Trying to estimate a monetary value for the QALY. Journal of Health Economics 2009;28:553–62;CrossRefGoogle Scholar Mason, H, Baker, R, Donaldson, C. Willingness to pay for a QALY: Past, present and future. Expert Reviews of Pharmacoeconomics and Outcomes Research 2008;8:575–82.CrossRefGoogle ScholarPubMed

16. See note 1, Dolan 2001.

17. See note 1, Dolan 2001.

18. See note 1, Dolan 2001, at 67.

19. Bentham, J. Chapter 1: Of the principle of utility. In: An Introduction to the Principles of Morals and Legislation. Mineola, NY: Dover Publications; 2007.

20. See, for example, Kymlicka W. Contemporary Political Philosophy: An Introduction. New York: Oxford University Press; 2002.

21. See note 20, Kymlicka 2002, at 10.

22. See note 20, Kymlicka 2002.

23. See note 20, Kymlicka 2002.

24. Hahn F. On some difficulties of the utilitarian economist, In: Sen A, Williams B, eds. Utilitarianism and Beyond. Cambridge: Cambridge University Press; 1982:187–99.

25. See note 20, Kymlicka 2002.

26. Sen A, Williams B. Introduction. In: Sen, Williams, 1982, at 4.

27. See note 26, Sen, Williams 1982, at 1–21.

28. Morgan Banks, L, Polack S. The economic costs of exclusion and gains of inclusion of people with disabilities: Evidence from low and middle income countries, CBM, International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, 2014: iv, 44; Lamicchane K. Disability, Education, and Employment in Developing Countries: From Charity to Investment. Delhi: Cambridge University Press; 2015, at 249; Lamicchane K, Sawadea Y. Disability and Returns to Education in a Developing Country (READ Discussion Paper). University of Tokyo, 2009.

29. Mortimer D, Segal L. Comparing the incomparable? A systematic review of competing techniques for converting descriptive measures of health status into QALY-weights. Medical Decision Making 2007:66–89; See note 4, Prieto, Sacristán 2003.

30. See note 1, Dolan 2001, at 67.

31. Nord E, Pinto JL, Richardson J, Menzel P, Ubel P. Incorporating societal concerns for fairness in numerical valuations of health programmes. Health Economics 1999;8(1):25–39.

32. Pliskin JS, Shepard DS, Weinstein MC. Utility functions for life years and health status. Operations Research 1980;28:206–24.

33. Beresniak A, Medina-Lara A, Auray JP, De Wever A, Praet JC, Tarricone R, et al. Validation of the underlying assumptions of the quality-adjusted life-years outcome: Results from the ECHOUTCOME European Project. PharmacoEconomics 2015;33(1):61–9.

34. See note 20, Kymlicka 2002.

35. Gudex C, Kind P. The QALY Toolkit. The Centre for Health Economics; Health Economics Consortium, University of York, c. 1986; available at https://www.york.ac.uk/che/pdf/dp38.pdf (last accessed September 2016).

36. McLaughlin K. Heartwarming moment dozens of cops and firefighters flocked to autistic boy’s birthday party after his heartbroken mom revealed none of his classmates turned up. Mail Online, February 22, 2015; available at http://www.dailymail.co.uk/news/article-2962916/Osceola-County-cops-flock-autistic-boy-s-birthday-party-mom-Ashlee-Buratti-revealed-none-classmates-turned-up.html (last accessed October 2016).

37. Hearing Hands - Touching ad by Samsung. YouTube, March 3, 2015; available at https://www.youtube.com/watch?v=UrvaSqN76h4&spfreload=10 (last accessed October 2016).