Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-16T15:16:18.609Z Has data issue: false hasContentIssue false
  • English
  • Français

Health Status Index Models for Use in Resource Allocation Decisions: A Critical Review in the Light of Observed Preferences for Social Choice

Published online by Cambridge University Press:  10 March 2009

Erik Nord
Erik Nord
Affiliation:
National Institute of Public HealthNorway
Get access Rights & Permissions [Opens in a new window]

Abstract

In the last two decades a number of health status index models have been developed for assessing the value of health outcomes in terms of quality-adjusted life years. The models can be tested by comparing their implications with direct observations of how societies think resources should be distributed across patient groups. This paper reviews empirical evidence of this kind from various countries and summarizes the evidence in three rules of thumb for selecting values for health states. Nine different models are judged relative to these rules of thumb. Eight of the models underestimate the strength of social preferences for treating the severely ill before the less severely ill. The ninth has a strong bias against states associated with emotional distress. As a consequence, none of the models can be seen as sufficient stand-alone instruments for valuing health outcomes. Instead, the models may be seen as complementary and adjustable parts of a tool kit that should also include the rules of thumb suggested in this paper.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 12 , Issue 1 , Winter 1996 , pp. 31 - 44
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Agt, H. M. E. van, Essink-Bot, M.-L., Krabbe, P. F. M., & Bonsel, G. J.Test-retest reliability of health state valuations collected with the EuroQol questionnaire. Social Science and Medicine, 1994, 39, 1537–44.CrossRefGoogle ScholarPubMed
2.Callahan, D.Setting mental health priorities: Problems and possibilities. The Milbank Quarterly, 1994, 72, 451–70.CrossRefGoogle Scholar
3.Campbell, A., & Gillett, G. Justice and the right to health care. In Ethical issues in defining core services. Wellington: The National Advisory Committee on Core Health and Disability Support Services, 1993.Google Scholar
4.Core Services Committee. Core services for 1995/1996. Wellington: Ministry of Health, 08 1994.Google Scholar
5.Daniels, N.Rationing fairly: Programmatic considerations. Bioethics, 1993, 7, 224–33.CrossRefGoogle ScholarPubMed
6.Drummond, M. F., Stoddart, G. L., & Torrance, G. W.Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 1987.Google Scholar
7.Dutch Committee on Choices in Health Care. Choices in health care. Rijswijk: Ministry of Welfare, Health and Cultural Affairs, 1992.Google Scholar
8.Eddy, D. M.Oregon's methods: Did cost-effectiveness analysis fail? Journal of the American Medical Association, 1991, 266, 2135–41.CrossRefGoogle ScholarPubMed
9.Gerard, K.Cost-utility in practice: A policy makers guide to the state of the art. Health Policy, 1992, 21, 249–79.CrossRefGoogle Scholar
10.Harris, J.QALYfying the value of life. Journal of Medical Ethics, 1987, 13, 117–23.CrossRefGoogle ScholarPubMed
11.Kaplan, R. M.Health outcome models for policy analysis. Health Psychology, 1989, 8, 723–35.CrossRefGoogle ScholarPubMed
12.Kaplan, R. M., & Anderson, J. P.A general health model: Update and applications. Health Services Research, 1988, 23, 203–35.Google ScholarPubMed
13.Kind, P., Rosser, R., & Williams, A. Valuations of life: Some psychometric evidence. In Jones-lee, M. W. (ed.), Value of life and safety. North Holland, 1982, 159–70.Google Scholar
14.Loomes, G., & McKenzie, L.The use of QALYs in health care decision making. Social Science and Medicine, 1989, 28, 299–308.CrossRefGoogle ScholarPubMed
15.Mooney, G., & Olsen, J. A. QALYs: Where next? In Mcguire, A. et al. (eds.). Providing health care: The economics of alternative systems of finance and delivery. New York: Oxford University Press, 1991.Google Scholar
16.Mulley, A. G.Assessing patients’ utilities: Can the end justify the means? Medical Care, 1989, 27, S269–81.CrossRefGoogle Scholar
17.Nord, E.An alternative to the QALY: The saved young life equivalent (SAVE). British Medical Journal, 1992, 305, 875–77.CrossRefGoogle Scholar
18.Nord, E.Helsepolitikere onsker ikke mest mulig helse per krone. (Health politicians do not wish to maximize health benefits.) Journal of the Norwegian Medical Association, 1993, 113, 1171–73.Google ScholarPubMed
19.Nord, E.Methods for quality adjustment of life years. Social Science and Medicine, 1992, 34, 559–69.CrossRefGoogle ScholarPubMed
20.Nord, E.Seminarserie om veiledende verditall for prioritering i helsevesenet. (Workshops on a value table for prioritizing in health care.) Working paper No. 1/1994. Oslo: National Institute of Public Health, 1994.Google Scholar
21.Nord, E.The person trade-off approach to valuing health care programs. Medical Decision Making, 1995, 15, 201–08.CrossRefGoogle ScholarPubMed
22.Nord, E.The QALY: A measure of social value rather than individual utility. Health Economics, 1994, 3, 89–93.CrossRefGoogle ScholarPubMed
23.Nord, E.The relevance of health state after treatment in prioritizing between patients. Journal of Medical Ethics, 1993, 19, 37–42.CrossRefGoogle Scholar
24.Nord, E.The trade-off between severity of illness and treatment effect in cost-value analysis of health care. Health Policy, 1993, 24, 227–38.CrossRefGoogle ScholarPubMed
25.Nord, E.The validity of a visual analogue scale in determining social utility weights for health states. International Journal of Health Planning and Management, 1991, 6, 234–42.Google ScholarPubMed
26.Nord, E.Towards quality assurance in QALY-calculations. International Journal of Technology Assessment in Health Care, 1993, 9, 37–45.CrossRefGoogle Scholar
27.Nord, E.Unjustified use of the Quality of Well-Being Scale in Oregon. Health Policy, 1993, 24, 45–53.CrossRefGoogle ScholarPubMed
28.Nord, E., Richardson, J., & Macarounas-Kirchmann, K.Social evaluation of health care versus personal evaluation of health states: Evidence on the validity of four health state scaling instruments using Norwegian and Australian surveys. International Journal of Technology Assessment in Health Care, 1993, 9, 463–78.CrossRefGoogle ScholarPubMed
29.Nord, E., Richardson, J., Street, A. et al. Maximising health benefits versus egalitarianism: An Australian survey of health issues. Social Science and Medicine, 1995, 41, 1429–37.CrossRefGoogle Scholar
30.Norwegian Commission for Prioritizing in Health Care. Retningslinjer for prioritering innen helsevesenet. (Guidelines for prioritizing in health care.) NOU 1987:23. Oslo: Universitetsforlaget, 1987.Google Scholar
31.Oregon Health Services Commission. Prioritization of health services: A report to the governor and legislature. Salem, OR: Oregon Health Services Commission, 1991.Google Scholar
32.Patrick, D. L., Bush, J. W., & Chen, M. M.Methods for measuring levels of well-being for a health status index. Health Services Research, 1973, 8, 228–45.Google ScholarPubMed
33.Pinto, J. L.The Oregon experience: Scales, numbers and their meaning. Paper for the 14th Spanish Meeting on Health Economics. Santiago de Compostela, 06 1994.Google Scholar
34.Rawls, J.A theory of justice. Cambridge, MA: Harvard University Press,1971.CrossRefGoogle Scholar
35.Rosser, R., Cottee, M., Rabin, R., & Selai, C. Index of health-related quality of life. In Hopkins, A. (ed.), Measures of the quality of life, and the uses to which they may be put. London: Royal College of Physicians of London,1992,81–90.Google Scholar
36.Rosser, R., & Kind, P.A scale of valuations of states of illness: Is there a social consensus? International Journal of Epidemiology, 1978, 7, 347–58.CrossRefGoogle Scholar
37.Sintonen, H. The 15D-measure of health related quality of life: Reliability, validity and sensitivity of its health state descriptive system. Working paper No. 42. Melbourne: National Centre for Health Program Evaluation, 1994.Google Scholar
38.Sintonen, H., & Pekurinen, M. A fifteen-dimensional measure of health-related quality of life (15 D) and its applications. In Walker, S. R., & Rosser, R. M. (eds.), Quality of life assessment: Key issues in the 1990s. Dordrecht: Kluwer Academic Publishers, 1993, 185–95.CrossRefGoogle Scholar
39.Swedish Health Care and Medical Priorities Commission. No easy choices: The difficulties of health care. SOU 1993:93. Stockholm: The Ministry of Health and Social Affairs, 1993.Google Scholar
40.The EuroQol Group. EuroQol: A new facility for the measurement of health related quality of life. Health Policy, 1990, 16, 199–208.CrossRefGoogle Scholar
41.Torrance, G. W., Boyle, M. H., & Horwood, S. P.Application of multi attribute utility theory to measure social preferences for health states. Operations Research, 1982, 30, 1043–69.CrossRefGoogle ScholarPubMed
42.Torrance, G. W., Zhang, Y., Feeny, D. H. et al. Multiattribute preference functions for a comprehensive health status classification system. Working paper No. 92–18. Hamilton: McMaster University, Centre for Health Economics and Policy Analysis, 1992.Google Scholar
43.Weinstein, M. C., & Stason, W. B.Foundations of cost-effectiveness analysis for health analysis and medical practices. New England Journal of Medicine, 1977, 296, 716–21.CrossRefGoogle ScholarPubMed
44.Williams, A. Ethics and efficiency in the provision of health care. In Bell, J. M. & Mendus, S. (eds.), Philosophy and medical welfare. New York, Cambridge University Press, 1988, 111–26.Google Scholar
45.Williams, A.The measurement and valuation of health: A chronicle. Discussion paper 136. York: Centre for Health Economics, 1995.Google Scholar
46.Williams, A.The role for the EuroQol Instrument in QALY calculations. Discussion paper 130. York: Centre for Health Economics, 1995.Google Scholar
47.Williams, A.Who is to live? A question for the economist or the doctor? World Hospitals, 1987, 13, 34–36.Google Scholar