Chisholm D, Healey A, Knapp M
Centre for the Economics of Mental Health (CEMH), University of London, UK.
Soc Psychiatry Psychiatr Epidemiol. 1997 Feb;32(2):68-75. doi: 10.1007/BF00788923.
Quality-adjusted life year measures (QALYs) have been fervently debated by researchers and decision makers concerned with resource allocation in the health care sector. They have been heralded as important aids to planning and priority setting, but also criticised on technical and ethical grounds. This paper examines these arguments with special reference to mental health care, the intention being to highlight the strengths and shortcomings of QALYs in this context. Issues pertinent to the application of QALYs in health care evaluation more generally are also reviewed. Whilst the rationale and underlying principles of the utility measurement approach are sound, the generic QALY as it is currently constructed represents an insensitive measure of the outcomes of mental health care. In the event of an increasingly QALY-driven priority-setting environment, however, abandonment of QALYs runs the risk of inappropriately marginalising people with mental illnesses in the resource allocation process. This opens up the possibility of developing a mental-health specific measure of utility that, in combination with cost data, would provide useful and appropriate summary information across treatments and programmes of mental health care.
质量调整生命年测量法（QALYs）一直是关注医疗保健领域资源分配的研究人员和决策者热烈讨论的话题。它们被誉为规划和确定优先事项的重要辅助工具，但也在技术和伦理方面受到批评。本文特别参照精神卫生保健来审视这些论点，目的是突出在此背景下QALYs的优点和缺点。与QALYs在更广泛的医疗保健评估中的应用相关的问题也会进行回顾。虽然效用测量方法的基本原理和基本原则是合理的，但目前构建的通用QALY是对精神卫生保健结果的一种不敏感的测量方法。然而，在一个日益由QALYs驱动的确定优先事项的环境中，放弃QALYs存在在资源分配过程中不适当地边缘化精神疾病患者的风险。这就为开发一种针对精神健康的效用测量方法开辟了可能性，这种方法与成本数据相结合，将为精神卫生保健的各种治疗和项目提供有用且合适的汇总信息。
