What is wrong with QALYs? – Healthcare Economist

by Msnbctv news staff

A paper by Rand and Kesselheim (2021) in Well being Affairs this month conducts a scientific literature overview to reply this query. Primarily based on 113 articles they recognized in peer-reviewed journals, they establish the next 10 criticisms classes.

The graph above has every criticism class and the variety of peer-reviewed articles that point out this critique kind. Every of those criticism classes are subdivided into particular critiques:

Criticism classSpecific criticism
Well being state measurementValidity of instruments to measure well being state;
Reliability amongst instruments;
Issue of self-reporting for some teams; (e.g., youngsters, dementia);
Insensitivity to particular situations or adjustments in well being;
Prescriptive definition of health-related high quality of life (excludes some well being domains and well-being past well being);
Utility MeasurementValidity of utility measurement;
Reliability between utility measures: completely different strategies produce completely different outcomes;
Elicited utilities are modified by the angle the query or responder takes, together with whether or not in poor health well being occurs now or later & risk-aversion;
Utility scores elicited from the general public are completely different from these of sufferers who expertise the well being state;
Utility values might change over the life course or not be mounted;
Particular person preferences should not suitable with the utility principle of QALYs: Folks don’t maintain time and high quality of life in a relentless proportional, linear trade-off;
Measures utilities per well being state somewhat than utility of shifting between well being states;
Dying shouldn’t be handled as a quality-of-life utility; it’s a time measurement
Unclear easy methods to worth sure situations or outcomes, equivalent to stillbirth
Nonhealth resultsSocial utility and externalities should not measured;
Results on dependents and advantages to others not measured;
Scientific spillover (future innovation or studying) not measured
Equal worth of QALY regardlesss of recepientsNeutrality general: equal worth to the QALY regardless of different traits of the recipients; QALYs ignore distribution of well being
Severity of the situation just isn’t accounted for in QALYs (that’s, beginning well being state not mirrored in QALY acquire);
QALYs ignore endpoint well being state (whether or not therapy leads to a poor well being state or whether or not a greater state would have been attainable);
QALY good points replicate capability to profit and magnitude somewhat than want or previous in poor health well being;
Aggregation of outcomesQALYs in whole counted, not particular person lives; assumes that good points can compensate for losses;
Doesn’t draw a distinction between saving or extending lives and bettering high quality of life;
Ignores whether or not a well being state was improved or decline prevented;
Aggregation of particular person preferencesPeople’ values & preferences are completely different, however they’re assumed to worth QALYs equally;
Utilities shouldn’t be interpersonally in contrast and aggregated;
People’ preferences shouldn’t apply to others;
Results for people could also be completely different from the common (outliers);
Well being
QALYs are insensitive to well being distribution, don’t account for fairness or equity;
QALY neutrality doesn’t replicate public preferences about well being fairness
AgeismBias by age as a result of remaining life expectancy means youthful populations can produce extra QALYs;
QALYs ought to weight well being good points for youthful populations to realize fairness in life expectancy;
situation discrimination
A incapacity or persistent situation reduces high quality of life and subsequently potential to achieve QALYs;
Folks with disabilities are sometimes unwilling to commerce off time for high quality of life, resulting in excessive utility scores for his or her well being state;

To search out out extra about every of those criticisms, do learn the entire paper right here.

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