Quintiles Professor of Pharmaceutical Development and Regulatory Innovation, School of Pharmacy, Price School of Public Policy, Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA. 635 Downey Way, VPD 414K, Los Angeles, CA 90089-3333, USA; National Bureau of Economic Research, Cambridge, MA, USA.
University Professor and Provost Emeritus, University of Rochester, Rochester, NY, 30250 South Highway One, Gualala, CA 95445, USA.
J Health Econ. 2020 Jul;72:102346. doi: 10.1016/j.jhealeco.2020.102346. Epub 2020 Jun 6.
Standard cost-effectiveness models compare incremental cost increases to incremental average gains in health, commonly expressed in Quality-Adjusted Life Years (QALYs). Our research generalizes earlier models in several ways. We introduce risk aversion in Quality of Life (QoL), which leads to "willingness-to-pay" thresholds that rise with illness severity, potentially by an order of magnitude. Unlike traditional CEA analyses, which discriminate against persons with disabilities, our analysis implies that the marginal value of improving QoL rises for disabled individuals. Our model can also value the uncertain benefits of medical interventions by employing well-established analytic methods from finance. Finally, we show that traditional QALYs no longer serve as a single index of health, when consumers are risk-averse. To address this problem, we derive a generalized single-index of health outcomes-the Generalized Risk-Adjusted QALY (GRA-QALY). Earlier models of CEA that abstract from risk-aversion nest as special cases of our more general model.
标准成本效益模型将增量成本增加与健康的增量平均收益进行比较，通常用质量调整生命年 (QALY) 来表示。我们的研究从几个方面推广了早期的模型。我们在生活质量 (QoL) 中引入了风险厌恶，这导致了“支付意愿”的门槛随着疾病严重程度的上升而上升，潜在的幅度可能达到一个数量级。与歧视残疾人士的传统成本效益分析不同，我们的分析表明，改善 QoL 的边际价值对残疾人士上升。我们的模型还可以通过使用金融领域成熟的分析方法来评估医疗干预的不确定收益。最后，我们表明，当消费者存在风险厌恶时，传统的 QALY 不再作为健康的单一指标。为了解决这个问题，我们推导出了一个广义的健康结果单一指数——广义风险调整 QALY (GRA-QALY)。从风险厌恶中抽象出来的早期成本效益分析模型是我们更通用模型的特例。
