The Ranking Properties of Healthy-Years Equivalents and Quality-Adjusted Life-Years Under Certainty and Uncertainty

1995 ◽  
Vol 11 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Magnus Johannesson
Keyword(s):  
Expected Utility ◽  
The Other ◽  
Quality Adjusted Life Years ◽  
Health States ◽  
Trade Off ◽  
Individual Preferences ◽  
Life Years ◽  
Ex Ante ◽  
Quality Adjusted Life ◽  
Health Profiles

AbstractThis paper investigates the theoretical properties of healthy-years equivalents (HYEs) and quality-adjusted life-years (QALYs). A distinction is made between ex ante HYEs (EA-HYEs) and expected HYEs (EXP-HYEs) and between risk-neutral quality-adjusted life-years (RN-QALYs) and risk-adjusted quality adjusted life-years (RA-QALYs). In the case of certainty, HYEs always rank health profiles according to individual preferences, whereas QALYs only rank health profiles according to individual preferences if constant proportional trade-off holds for all health states and if additive independence of quality in different periods holds. In the case of uncertainty, EA-HYEs always rank risky health profiles the same way as expected utility. The assumptions needed for the other measures to rank risky health profiles the same way as expected utility are: risk neutrality with respect to healthy time for EXP-HYEs; risk neutrality with respect to time in all health states and additive independence of quality in different periods for RN-HYEs; and constant proportional risk posture with respect to time in all health states and additive independence of quality in different periods for RA-QALYs.

scholarly journals Methods for the economic evaluation of changes to the organisation and delivery of health services: principal challenges and recommendations

2018 ◽  
Vol 14 (1) ◽  
pp. 119-134 ◽  
Author(s):  
Rachel Meacock
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Health Services ◽  
Opportunity Costs ◽  
Quality Adjusted Life Years ◽  
Health Technologies ◽  
Life Years ◽  
Ex Ante ◽  
Delivery Of Health Services ◽  
Quality Adjusted Life

AbstractThere is a requirement for economic evaluation of health technologies seeking public funding across Europe. Changes to the organisation and delivery of health services, including changes to health policy, are not covered by such appraisals. These changes also have consequences for National Health Service (NHS) funds, yet undergo no mandatory cost-effectiveness assessment. The focus on health technologies may have occurred because larger-scale service changes pose more complex challenges to evaluators. This paper discusses the principal challenges faced when performing economic evaluations of changes to the organisation and delivery of health services and provides recommendations for overcoming them. The five principal challenges identified are as follows: undertakingex-anteevaluation; evaluating impacts in terms of quality-adjusted life years; assessing costs and opportunity costs; accounting for spillover effects; and generalisability. Of these challenges, methods for estimating the impact on costs and quality-adjusted life years are those most in need of development. Methods are available forex-anteevaluation, assessing opportunity costs and examining generalisability. However, these are rarely applied in practice. The general principles of assessing the cost-effectiveness of interventions should be applied to all NHS spending, not just that involving health technologies. Advancements in this area have the potential to improve the allocation of scarce NHS resources.

A FALLACY OF THE MULTIPLICATIVE QALY MODEL FOR LOW-QUALITY WEIGHTS IN STUDENTS AND PATIENTS JUDGING HYPOTHETICAL HEALTH STATES

2001 ◽  
Vol 17 (4) ◽  
pp. 488-496 ◽  
Author(s):  
Peep F. M. Stalmeier ◽  
Gretchen B. Chapman ◽  
Angela G. E. M. de Boer ◽  
Jan J. B. van Lanschot
Keyword(s):  
Poor Health ◽  
Quality Adjusted Life Years ◽  
Positive Health ◽  
Present Contribution ◽  
Health States ◽  
Reversal Phenomenon ◽  
Life Years ◽  
Preference Reversal Phenomenon ◽  
Quality Adjusted Life

Objectives: In quality-adjusted life-years (QALY) models, it is customary to weigh life-years with quality of life via multiplication. As a consequence, for positive health states a longer duration has more QALYs than a shorter duration (i.e., longer is better). However, we have found that for poor health states, many prefer to live only a limited amount of time (i.e., longer is worse). Such preferences are said to be maximum endurable time (MET). In the present contribution, the following questions are asked: a) How low does the utility have to be in order for a MET to arise? and b) Do MET preferences occur when patients judge hypothetical health states?Methods and Results: We reanalyzed data from 176 students for the hypothetical health states of “living with migraines” and “living with metastasized cancer.” For utilities smaller than 0.7 (ranging from 0 to 1), the MET preference rate was larger than 50%. High MET preference rates were also found in two new studies on migraine and esophageal cancer patients, who evaluated hypothetical health states related to their disease.Conclusions: We discuss the interpretation of the MET preferences and the preference reversal phenomenon. Standard QALY models imply that longer is better. However, we find that more often, longer is worse for poorly evaluated health states. Consider the following question: are 3 years with a weight of 0.3 equally as valuable as 1 year with a weight of 0.9? Our results suggest that the 3-year period may be less valuable because for poor health, many will prefer a 1-year over a 3-year period.

Quality-adjusted life years assessment using cabozantinib for patients with advanced hepatocellular carcinoma (aHCC) in the CELESTIAL trial.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 207-207 ◽  
Author(s):  
Ghassan K. Abou-Alfa ◽  
Patrick Mollon ◽  
Tim Meyer ◽  
Ann-Lii Cheng ◽  
Anthony B. El-Khoueiry ◽  
...  
Keyword(s):  
Minimal Important Difference ◽  
Health Utility ◽  
Advanced Hepatocellular Carcinoma ◽  
Life Questionnaire ◽  
Quality Adjusted Life Years ◽  
Small Reduction ◽  
Health States ◽  
Life Years ◽  
The Difference ◽  
Quality Adjusted Life

207 Background: In patients previously treated for aHCC, cabozantinib (cabo) led to longer overall survival and progression-free survival vs placebo (pbo) in the randomized, phase 3 CELESTIAL trial (NCT01908426; N = 707). CELESTIAL was stopped early for benefit at the second interim analysis. This post hoc analysis estimated the incremental quality-adjusted life years (QALYs) accrued in CELESTIAL. Methods: Health utility was elicited at each study visit using the EQ-5D-5L quality of life questionnaire. (completed by 82–100% of patients overall). UK crosswalk tariffs were applied for health states. Cumulative QALYs by patient were calculated by linear interpolation; for patients who were censored (31% of patients; including 9% within 100 days of randomization), the last observed utility value was carried forward to study end. The difference in restricted mean QALYs was calculated using generalized linear models, accounting for baseline utility, and with 0.06–0.08 QALYs considered the minimal important difference. Results: At day 50 after randomization (acute treatment phase), cabo was associated with a small reduction in mean total QALYs vs pbo (difference −0.003; 95% CI −0.005 to −0.002; p ≤ 0.001; n = 601 [cabo, n = 389; pbo, n = 212]). At day 100, there was a numerical benefit in mean total QALYs for cabo (difference +0.007; 95% CI −0.001 to 0.015; p = 0.103; n = 627 [cabo, n = 410; pbo, n = 217]), and at day 150 the difference was +0.032 QALYs (95% CI 0.017 to 0.047; p ≤ 0.001; n = 629 [cabo, n = 412; pbo, n = 217]) in favor of cabo. Over the entire follow-up, patients randomized to cabo accrued a mean of +0.092 (95% CI 0.016 to 0.169; p = 0.018; n = 700 [cabo, n = 465; pbo, n = 235]) additional QALYs compared with those receiving pbo. Using alternative Devlin weights for health states, the mean accrued QALYs with cabo was +0.115 vs pbo (95% CI 0.032 to 0.198; p = 0.007). Conclusions: Cabo was associated with an initial, small reduction in health utility. However, with continued treatment, health utility increased and at the end of the study there was a clinically and statistically significant benefit in mean QALYs in favor of cabo. Clinical trial information: NCT01908426.

Tests of Preferential Independence in the QALY Model

1998 ◽  
Vol 18 (4) ◽  
pp. 418-428 ◽  
Author(s):  
Jonathan R. Treadwell
Keyword(s):  
Lower Bound ◽  
Key Words ◽  
Discount Rate ◽  
Health State ◽  
Quality Adjusted Life Years ◽  
Health Changes ◽  
Life Years ◽  
Tests Of Independence ◽  
Quality Adjusted Life ◽  
Health Profiles

The author presents evidence for the descriptive adequacy of the quality-adjusted life years (QALY) model as applied to health profiles. One important assumption of the model is preferential independence: if two profiles have the same health state during year X, then preference between them does not switch if the level of health changes during year X. In experiment 1, 30-year health profiles were used to perform 27 em pirical tests of independence with 98 subjects. Independence was reliably satisfied in all 27 tests. In experiment 2, 15 additional tests were conducted. These tests had been specifically designed to be more sensitive to independence violations, but indepen dence was still mostly satisfied. In both experiments, the conclusions about indepen dence hold regardless of what discount rate is used. These results act as a "lower bound" on the validity of the QALY model for health profiles. Key words: quality-ad justed life years; QALY model; health profiles; preferential independence. (Med Decis Making 1998;18:418-428)

Review and estimation of disutility for joint health states of severe and nonsevere hypoglycemic events in diabetes

2021 ◽  
Author(s):  
Xuanqian Xie ◽  
Jennifer Guo ◽  
Karen E Bremner ◽  
Myra Wang ◽  
Baiju R Shah ◽  
...  
Keyword(s):  
Construct Validity ◽  
Literature Search ◽  
Economic Evaluations ◽  
Quality Adjusted Life Years ◽  
Health States ◽  
Life Years ◽  
Joint Health ◽  
Biased Estimates ◽  
Quality Adjusted Life ◽  
Additive Methods

Aim: Many economic evaluations used linear or log-transformed additive methods to estimate the disutility of hypoglycemic events in diabetes, both nonsevere (NSHEs) and severe (SHEs). Methods: We conducted a literature search for studies of disutility for hypoglycemia. We used additive, minimum and multiplicative methods, and the adjusted decrement estimator to estimate the disutilities of joint health states with both NSHEs and SHEs in six scenarios. Results: Twenty-four studies reported disutilities for hypoglycemia in diabetes. Based on construct validity, the adjusted decrement estimator method likely provides less biased estimates, predicting that when SHEs occur, the additional impact from NSHEs is marginal. Conclusion: Our proposed new method provides a different perspective on the estimation of quality-adjusted life-years in economic evaluations of hypoglycemic treatments.

scholarly journals Optimal threshold estimator of a prognostic marker by maximizing a time-dependent expected utility function for a patient-centered stratified medicine

2016 ◽  
Vol 27 (6) ◽  
pp. 1847-1859 ◽  
Author(s):  
Etienne Dantan ◽  
Yohann Foucher ◽  
Marine Lorent ◽  
Magali Giral ◽  
Philippe Tessier
Keyword(s):  
Utility Function ◽  
Kidney Transplant ◽  
Expected Utility ◽  
Time Dependent ◽  
Optimal Threshold ◽  
Stratified Medicine ◽  
Quality Adjusted Life Years ◽  
Patient Centered ◽  
Life Years ◽  
Quality Adjusted Life

Defining thresholds of prognostic markers is essential for stratified medicine. Such thresholds are mostly estimated from purely statistical measures regardless of patient preferences potentially leading to unacceptable medical decisions. Quality-Adjusted Life-Years are a widely used preferences-based measure of health outcomes. We develop a time-dependent Quality-Adjusted Life-Years-based expected utility function for censored data that should be maximized to estimate an optimal threshold. We performed a simulation study to compare estimated thresholds when using the proposed expected utility approach and purely statistical estimators. Two applications illustrate the usefulness of the proposed methodology which was implemented in the R package ROCt ( www.divat.fr ). First, by reanalysing data of a randomized clinical trial comparing the efficacy of prednisone vs. placebo in patients with chronic liver cirrhosis, we demonstrate the utility of treating patients with a prothrombin level higher than 89%. Second, we reanalyze the data of an observational cohort of kidney transplant recipients: we conclude to the uselessness of the Kidney Transplant Failure Score to adapt the frequency of clinical visits. Applying such a patient-centered methodology may improve future transfer of novel prognostic scoring systems or markers in clinical practice.

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.

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