Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-05T14:41:28.336Z Has data issue: false hasContentIssue false
  • English
  • Français

Calibrating QALYs to Respect Equality of Persons

Published online by Cambridge University Press:  23 June 2016

DONALD FRANKLIN
DONALD FRANKLIN*
Affiliation:
UK Department of Health, University College [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Comparative valuation of different policy interventions often requires interpersonal comparability of benefit. In the field of health economics, the metric commonly used for such comparison, quality adjusted life years (QALYs) gained, has been criticized for failing to respect the equality of all persons’ intrinsic worth, including particularly those with disabilities. A methodology is proposed that interprets ‘full quality of life’ as the best health prospect that is achievable for the particular individual within the relevant budget constraint. This calibration is challenging both conceptually and operationally as it shifts dramatically when technology or budget developments alter what can be achieved for incapacitated individuals. The proposal nevertheless ensures that the maximal achievable satisfaction of one person's preferences can carry no more intrinsic value than that of another. This approach, which can be applied to other domains of social valuation, thus prevents implicit discrimination against the elderly and those with irremediable incapacities.

Type
Research Article
Information
Utilitas , Volume 29 , Issue 1 , March 2017 , pp. 65 - 87
Check for updates
Copyright
Copyright © Cambridge University Press 2016 

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

1 Persad, Govind, Wertheimer, Alan and Emanuel, Ezekiel J, ‘Principles for Allocation of Scarce Medical Interventions’, The Lancet, vol. 373, issue 9661, 31 January 2009, pp. 423–31CrossRefGoogle ScholarPubMed, at 427

2 Nord, E., Pinto, J. L., Richardson, J., Menzel, P. and Ubel, P., ‘Incorporating Concerns for Fairness in Numerical Valuation Of Health Programmes’, Health Economics 8 (1999), pp. 25–39 3.0.CO;2-H>CrossRefGoogle Scholar, at 36.

3 Nord, E., Menzel, P. and Richardson, J., ‘The Value Of Life: Individual Preferences and Social Choice: A Comment to Magnus Johannesson’, Health Economics 12 (2003), pp. 873–7CrossRefGoogle Scholar, at 873.

4 I am grateful to Richard Cookson for the challenge presented by this example, which is picked up again at the end of section III.

5 Dworkin, Ronald, ‘Justice in the Distribution of Health Care’, McGill Law Journal 38.4 (1993), pp. 883–98Google ScholarPubMed, at 888.

6 Dworkin, ‘Justice in the Distribution of Health Care’, p. 889.

7 Dworkin, ‘Justice in the Distribution of Health Care’, p. 890.

8 Ubel, Peter A., Nord, E., Gold, M., Menzel, P., Prades, J. L. and Richardson, J., ‘Improving Value Measurement in Cost-Effectiveness Analysis’, Med Care 38 (2000), pp. 892–901 CrossRefGoogle Scholar.

9 Nord et al., ‘The Value of Life’, p. 875.

10 Bleichrodt, H., Herrero, C. and Pinto, J. L., ‘A Proposal to Solve the Comparability Problem in Cost-Utility Analysis’, Journal of Health Economics 21 (2002), pp. 397–403 CrossRefGoogle ScholarPubMed, at 398.

11 Nord et al., ‘The Value of Life’, p. 873.

12 Sen, A., ‘Interpersonal Comparisons of Welfare’, essay 12 in Choice, Welfare and Measurement (Cambridge, MA, 1982)Google Scholar, see particularly sec. 4, ‘Comparability Types: Formal Structures’.

13 Sen, A., Development as Freedom (Oxford, 1999)Google Scholar, p. 56.

14 Franklin, Donald, Groups in Conflict: Equality versus Community (Cardiff, 2008)Google Scholar, see particularly ch. 1: ‘The Doctrine of Equal Human Worth’, pp. 20-9.

15 Donald Franklin, ‘Valuing the Time of Your Life’ (under review).

16 Broome, John, Weighing Lives (Oxford, 2004)CrossRefGoogle Scholar, ch. 7.

17 E.g. P. Dolan, C. Gudex, P. Kind and A. Williams, ‘A Social Tariff for EuroQoL: Results from a UK General Population Survey’, University of York: Centre for Health Economics, 1995, Discussion Paper 138.

18 I am grateful to the following for perceptive comments: Eric Nord, Tongtong Qian, the Editor and an anonymous reviewer for Utilitas, members respectively of the Golders Green Kreis, of the Health Economics Study Group of the United Kingdom, and of the London Economics Journal Club of the UK Department of Health. Views expressed are not necessarily those of the Department of Health.