Norwegian Institute of Public Health, Nydalen, P.O. Box 4404, 0403, Oslo, Norway.
Eur J Health Econ. 2018 Mar;19(2):267-275. doi: 10.1007/s10198-017-0882-x. Epub 2017 Mar 3.
The QALY is a useful outcome measure in cost-effectiveness analysis. But in determining the overall value of and societal willingness to pay for health technologies, gains in quality of life and length of life are prima facie separate criteria that need not be put together in a single concept. A focus on costs per QALY can also be counterproductive. One reason is that the QALY does not capture well the value of interventions in patients with reduced potentials for health and thus different reference points. Another reason is a need to separate losses of length of life and losses of quality of life when it comes to judging the strength of moral claims on resources in patients of different ages. An alternative to the cost-per-QALY approach is outlined, consisting in the development of two bivariate value tables that may be used in combination to estimate maximum cost acceptance for given units of treatment-for instance a surgical procedure, or 1 year of medication-rather than for 'obtaining one QALY.' The approach is a follow-up of earlier work on 'cost value analysis.' It draws on work in the QALY field insofar as it uses health state values established in that field. But it does not use these values to weight life years and thus avoids devaluing gained life years in people with chronic illness or disability. Real tables of the kind proposed could be developed in deliberative processes among policy makers and serve as guidance for decision makers involved in health technology assessment and appraisal.
QALY 是成本效益分析中的一种有用的结果衡量指标。但是，在确定卫生技术的总体价值和社会支付意愿时，生活质量的提高和寿命的延长是初步的独立标准，不需要在一个单一的概念中结合起来。对每 QALY 的成本的关注也可能会适得其反。一个原因是，QALY 不能很好地捕捉对健康潜力降低的患者的干预措施的价值，因此也没有不同的参考点。另一个原因是，在判断不同年龄患者的资源道德诉求的力度时，需要将寿命的损失和生活质量的损失分开。替代成本效益比方法的方法概述如下，包括开发两个双变量价值表，这些表可以结合使用来估计给定治疗单位的最大成本接受度，例如手术或 1 年的药物治疗，而不是为了“获得一个 QALY”。该方法是对“成本价值分析”的早期工作的跟进。它借鉴了 QALY 领域的工作，因为它使用了该领域确定的健康状态值。但是，它不会使用这些值来权衡生命年，从而避免对患有慢性疾病或残疾的人进行生命年的低估。可以在决策者之间的审议过程中制定这类真实表格，并作为参与卫生技术评估和评估的决策者的指导。
