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Economic Analysis and Outcome Assessment
Published in Kelly H. Zou, Lobna A. Salem, Amrit Ray, Real-World Evidence in a Patient-Centric Digital Era, 2023
Jean-Pascal Roussy, Kelly H. Zou
A common measure of patient benefit is the quality-adjusted life-year (QALY). The economic evaluations using the QALY as the measure of effectiveness are referred to as cost-utility analyses (CUAs), a subset of CEAs. The QALY adjusts the duration of life with the health state utility, i.e., the quality of life experienced by a patient while under a specific health state. This health state utility varies between 0 (quality of life equivalent to death) and 1 (perfect quality of life). CUAs produce an incremental cost-utility ratio (ICUR) representing the cost to gain one additional QALY when using the newer technology instead of its alternative (Higgins et al., 2012). The use of the QALY, as a standard measure of effectiveness, has the advantage of allowing value comparison across health technologies developed for unrelated disease areas. The results can be compiled and ranked in a league table to contrast the performances of various interventions. Of note, for this exercise to be valid, the studies included must have consistent methodologies (e.g., study timeframe, perspective, discounting of costs and benefits) (Mauskopf, 2003; Wilson, 2019).
Social justice and public health
Published in Sridhar Venkatapuram, Alex Broadbent, The Routledge Handbook of Philosophy of Public Health, 2023
While not referencing utilitarianism directly by name, Nancy Edwards and Colleen Davison argue that “some distancing from public health’s social justice values” (2008: 102) occurred following a mid-twentieth-century shift toward reductionist thinking and an increased demand for empirical evidence to support public health interventions. For some, the use (and, often, reliance) on cost-effectiveness analyses and expert-determined indices of health status in public health, such as quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs), represents a utilitarian approach to producing the greatest amount of health for the greatest number of people (Jonsen 1986; Kotalik 2006). Indeed, some consider utilitarianism to be one of the leading frameworks for contemporary health policy and welfare economics (Ruger 2010; Weinstein 1990; Weinstein and Stason 1977). Though, despite the ubiquity of utilitarianism in public health discourse, it is worth noting that it is far less common to find an unabashed defense or justification of a commitment to utilitarianism in philosophical treatments of public health in contrast to what as is found with non-utilitarian commitments to social justice.
Disability, Ideology, and Quality of Life
Published in Joel Michael Reynolds, Christine Wieseler, The Disability Bioethics Reader, 2022
The concept of health-related quality of life (HRQOL) is sometimes used in this context. This use of HRQOL as a substitute for QOL is simply the gerrymandering of social problems into medical ones. If disability is defined as a health-related problem, then the QALY advocates can use health care priorities as a stick to beat disabled people. The same treatment would not be tolerated with respect to sex or race. Consider again the three sisters. They are biomedically indistinguishable, but they differ immensely in their HSI-defined “mobility.” The opportunity restrictions experienced by Sister 3 (the least mobile) are caused not by her biomedical condition but by her inaccessible surroundings. This fact is merely disguised by referring to her “health-related quality of life.” Sister 3 is already penalized by her inaccessible environment. To compound the penalty by cutting her health care because of her inaccessible environment would surely be unjust.
Health burdens amid COVID-19 pandemic: A stark barrier to labor productivity in Africa
Published in Health Care for Women International, 2023
Health-related events have suggested that the health burden - increasing illness burden, mortality, and morbidity, as well as poor healthy life expectancy - is a major barrier to development and growth in African countries. In Africa, the burden of disease is a significant impediment to labor productivity (Sachs, 2001). Despite the significant success made in redirecting catastrophic health burdens among different socioeconomic groups in Africa over the previous decades, life for many people remains difficult. Health burden is calculated using Health-Adjusted Life Years (HALYs), which is a computation of the cumulative effects of morbidity and death, allowing for comparisons across interventions or illnesses in different populations. HALYs is measured using two different methods. These include Disability-Adjusted Life Years (DALYs), which compares current population health to the age of standard life expectancy in perfect health, and Quality-Adjusted Life Years (QALYs), which assesses both quantity and quality of life lived (WHO, Global Health Estimates, 2017 and Max & Hannah, 2018). Thus, in the context of this paper, the author described health burden following the World Health Organization, as a negative term that refers to financial challenges and losses caused by diseases, illnesses, incapacity, morbidity and mortality.
QALYs and ambulatory status: societal preferences for healthcare decision making
Published in Journal of Medical Economics, 2022
Lorna L. Freath, Alistair S. Curry, David M. W. Cork, Ivana F. Audhya, Katherine L. Gooch
The QALY is the most commonly used health outcome measure for cost-effectiveness analysis of new interventions1, providing a standardized approach to optimize distribution of healthcare resources across all diseases, treatments, and populations. The QALY is calculated by multiplying the health-related quality of life (HRQoL) value for the health state (utility) by the number of years a patient is expected to live in the health state. Utilities can be derived using a number of methods. One of the most commonly used methods preferred by health technology assessment bodies is based on patients completing preference-based measures such as the EQ-5D or HUI, which define the health state they are in. A utility value for this health state is then estimated using the scoring algorithm (“QALY weights” or a “tariff”) derived for the health states that the EQ-5D describes via a representative sample of the general population. Depending on the nature of the condition (i.e. cognitively unaware individuals) and/or age of participants it may be necessary to rely on caregivers or other proxy respondents to complete the EQ-5D. Utilities assigned to health states can also be collected directly by asking respondents to provide their preferences for health states using standard gamble or time trade-off methods.
Cost-effectiveness of pembrolizumab for the first-line treatment of recurrent or metastatic head and neck squamous cell carcinoma in the United States
Published in Journal of Medical Economics, 2022
Rebekah H. Borse, Karthik Ramakrishnan, Jyotika Gandhi, Praveen Dhankhar, Diana Chirovsky
Sensitivity analyses were performed which are described in Supplemental Material (Table S7). A one-way deterministic sensitivity analysis (DSA) was described to assess the magnitude of the variations in the incremental cost-effectiveness ratios (ICERs) induced by changes made in one parameter value. The results are summarized via a tornado diagram which ranks the 15 most influential parameters on the incremental cost per QALY gained with pembrolizumab vs. the EXTREME regimen. Uncertainty was further assessed through probabilistic sensitivity analysis (PSA), using 1000 iterations, in which standard errors or variance–covariance matrices for the selected parameter distributions were based on original data sources, when available, and otherwise were set at 20% of the mean values. In the current analysis, $100,000 per QALY was assumed as the threshold for cost-effectiveness, in alignment with the Institute for Clinical and Economic Review which uses the range of $100,000 to $150,000 per QALY as the standard value for health benefits for all economic assessments for the US61. The results of the PSA are plotted graphically on cost-effectiveness acceptability curves showing the probabilities of cost-effectiveness at different willingness to pay thresholds going from $50,000 to $250,000 per QALY.