Treatment options for localized prostate cancer: quality-adjusted life years and the effects of lead-time

Urology ◽  
2004 ◽  
Vol 63 (1) ◽  
pp. 103-109 ◽  
Author(s):  
Vibha Bhatnagar ◽  
Susan T. Stewart ◽  
William W. Bonney ◽  
Robert M. Kaplan
Keyword(s):  
Prostate Cancer ◽  
Lead Time ◽  
Treatment Options ◽  
Localized Prostate Cancer ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Quality Adjusted Life

The Danger of Applying Group-level Utilities in Decision Analyses of the Treatment of Localized Prostate Cancer in Individual Patients

1998 ◽  
Vol 18 (4) ◽  
pp. 376-380 ◽  
Author(s):  
Mark E. Cowen ◽  
Brian J. Miles ◽  
Daniel F. Cahill ◽  
R. Brian Giesler ◽  
J. Robert Beck ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Analysis ◽  
Localized Prostate Cancer ◽  
Group Level ◽  
Quality Adjusted Life Years ◽  
Individual Level ◽  
Life Years ◽  
Life Years Lost ◽  
The Individual ◽  
Quality Adjusted Life

The optimal management strategy for men who have localized prostate cancer remains controversial. This study examines the extent to which suggested treatment based on the perspective of a group or society agrees with that derived from individual patients' preferences. A previously published decision analysis for localized prostate cancer was used to suggest the treatment that maximized quality-adjusted life expectancy. Two treatment recommendations were obtained for each patient: the first (group-level) was derived using the mean utilities of the cohort; the second (individual-level) used his own set of utilities. Group-level utilities misrepresented 25-48% of individuals' pref erences depending on the grade of tumor modeled. The best kappa measure achieved between group and individual preferences was 0.11. The average quality-adjusted life years lost due to misrepresentation of preference was as high as 1.7 quality-adjusted life years. Use of aggregated utilities in a group-level decision analysis can ignore the substantial variability at the individual level. Caution is needed when applying a group- level recommendation to the treatment of localized prostate cancer in an individual patient. Key words: decision analysis; utility assessment; prostate cancer; patient pref erences. (Med Decis Making 1998;18:376-380)

Comparative effectiveness of treatment options for pediatric craniopharyngiomas

2014 ◽  
Vol 13 (2) ◽  
pp. 178-188 ◽  
Author(s):  
Zarina S. Ali ◽  
Robert L. Bailey ◽  
Lawrence B. Daniels ◽  
Venus Vakhshori ◽  
Daniel J. Lewis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Surgical Approaches ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Subtotal Removal ◽  
Quality Adjusted Life

Object No clear treatment guidelines for pediatric craniopharyngiomas exist. The authors developed a decision analytical model to evaluate outcomes of 4 surgical approaches for craniopharyngiomas in children, including attempted gross-total resection (GTR), planned subtotal removal plus radiotherapy, biopsy plus radiotherapy, and endoscopic resections of all kinds. Methods Pooled data, including the authors' own experience, were used to create evidence tables, from which incidence, relative risks, and summary outcomes in quality-adjusted life years (QALYs) were calculated for the 4 management strategies. Results Quality-adjusted life years at the 5-year follow-up were 2.3 ± 0.1 for attempted GTR, 2.9 ± 0.2 for planned subtotal removal plus radiotherapy, 3.9 ± 0.2 for biopsy plus radiotherapy, and 3.7 ± 0.2 for endoscopic resection (F = 17,150, p < 0.001). Similarly, QALYs at 10-year follow-up were 4.5 ± 0.2 for attempted GTR, 5.7 ± 0.5 for planned subtotal removal plus radiotherapy, and 7.8 ± 0.5 for biopsy plus radiotherapy (F = 6,173, p < 0.001). On post hoc pairwise comparisons, the differences between all pairs compared were also highly significant (p < 0.001). Since follow-up data at 10 years are lacking for endoscopic cases, this category was excluded from 10-year comparisons. Conclusions Biopsy with subsequent radiotherapy is the preferred approach with respect to improved overall quality of life. While endoscopic approaches also show promise in preserving quality of life at five-year follow-up, there are not sufficient data to draw conclusions about this comparison at 10 years.

scholarly journals Bursting Bubbles? QALYs and Discrimination

Utilitas ◽  
2018 ◽  
Vol 31 (2) ◽  
pp. 191-202
Author(s):  
BEN DAVIES
Keyword(s):  
Patient Preferences ◽  
Treatment Options ◽  
People With Disabilities ◽  
Quality Adjusted Life Years ◽  
Allocation System ◽  
Life Years ◽  
Cyclic Preferences ◽  
Quality Adjusted Life

The use of Quality-Adjusted Life Years (QALYs) in healthcare allocation has been criticized as discriminatory against people with disabilities. This article considers a response to this criticism from Nick Beckstead and Toby Ord. They say that even if QALYs are discriminatory, attempting to avoid discrimination – when coupled with other central principles that an allocation system should favour – sometimes leads to irrationality in the form of cyclic preferences. I suggest that while Beckstead and Ord have identified a problem, it is a misdiagnosis to lay it at the feet of an anti-discrimination principle. The problem in fact comes from a basic tension between respecting reasonable patient preferences and other ways of ranking treatment options. As such, adopting a QALY system does not solve the problem they identify.

Identifying Public Health Problems

2018 ◽  
Author(s):  
Scott Burris ◽  
Micah L. Berman ◽  
Matthew Penn, and ◽  
Tara Ramanathan Holiday
Keyword(s):  
Public Health ◽  
Health Problems ◽  
Health Priorities ◽  
Disability Adjusted Life Years ◽  
Quality Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Study Designs ◽  
Quality Adjusted Life

Chapter 5 discusses the use of epidemiology to identify the source of public health problems and inform policymaking. It uses a case study to illustrate how researchers, policymakers, and practitioners detect diseases, identify their sources, determine the extent of an outbreak, and prevent new infections. The chapter also defines key measures in epidemiology that can indicate public health priorities, including morbidity and mortality, years of potential life lost, and measures of lifetime impacts, including disability-adjusted life years and quality-adjusted life years. Finally, the chapter reviews epidemiological study designs, differentiating between experimental and observational studies, to show how to interpret data and identify limitations.

Medicare’s Hospital Value-Based Purchasing Program Values Quality over QALYs

2021 ◽  
pp. 0272989X2110171
Author(s):  
Edward C. Norton ◽  
Jun Li ◽  
Anup Das ◽  
Andrew M. Ryan ◽  
Lena M. Chen
Keyword(s):  
Quality Of Care ◽  
Pay For Performance ◽  
Health Interventions ◽  
Quality Adjusted Life Years ◽  
Value Based Purchasing ◽  
Quality Performance ◽  
Life Years ◽  
Policy Adjustments ◽  
Quality Adjusted Life

Medicare’s Hospital Value-Based Purchasing Program (HVBP) is the first national pay-for-performance program to combine measures of quality of care with a measure of episode spending. We estimated the implicit tradeoffs between mortality reduction and spending reduction. To earn points in HVBP, a hospital can either lower mortality or reduce spending, creating a tradeoff between the 2 measures. We analyzed the quality performance and earned points of 2814 hospitals using publicly available data. We then quantified the tradeoffs between spending and mortality in terms of quality-adjusted life-years (QALYs). If incentives in the program were balanced, then the tradeoff between spending and QALYs should be comparable with those of high-value health interventions, roughly $50,000 to $200,000 per QALY. Instead, the tradeoff in HVBP was about $1.2 million per QALY. HVBP overvalues improvements in quality of care relative to spending reductions. We propose 2 possible policy adjustments that could improve incentives for hospitals to deliver high-value care.

Good, Fairness and QALYs

1988 ◽  
Vol 23 ◽  
pp. 57-73 ◽  
Author(s):  
John Broome
Keyword(s):  
Health Service ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Quality Adjusted Life

Counting QALYs (quality adjusted life years) has been proposed as a way of deciding how resources should be distributed in the health service: put resources where they will produce the most QALYs. This proposal has encountered strong opposition. There has been a disagreement between some economists favouring QALYs and some philosophers opposing them. But the argument has, I think, mostly been at cross-purposes. Those in favour of QALYs point out what they can do, and those against point out what they can't. There need be no disagreement about this. What is needed is to sort out what is the proper domain of QALYs, and it may be possible to do this amicably. Then we may be able to get on with the more useful job of deciding how well QALYs perform within their domain. In this paper I shall try to accomplish the first task (sections II–IV), and make a start on the second (sections V–VIII).

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