Quality of Life and Resource Allocation

1988 ◽  
Vol 23 ◽  
pp. 33-55 ◽  
Author(s):  
Michael Lockwood
Keyword(s):  
Quality Of Life ◽  
Resource Allocation ◽  
Quality Adjusted Life Year ◽  
Medical Resources ◽  
Medical Vocabulary ◽  
Quality Adjusted Life

A new word has recently entered the British medical vocabulary. What it stands for is neither a disease nor a cure. At least, it is not a cure for a disease in the medical sense. But it could, perhaps, be thought of as an intended cure for a medicosociological disease: namely that of haphazard or otherwise ethically inappropriate allocation of scarce medical resources. What I have in mind is the term ‘QALY’, which is an acronym standing for quality adjusted life year. Just what this means and what it is intended to do I shall explain in due course. Let me first, however, set the scene.

Quality of Life and Resource Allocation

1988 ◽  
Vol 23 ◽  
pp. 33-55
Author(s):  
Michael Lockwood
Keyword(s):  
Quality Of Life ◽  
Resource Allocation ◽  
Quality Adjusted Life Year ◽  
Medical Resources ◽  
Medical Vocabulary ◽  
Quality Adjusted Life

A new word has recently entered the British medical vocabulary. What it stands for is neither a disease nor a cure. At least, it is not a cure for a disease in the medical sense. But it could, perhaps, be thought of as an intended cure for a medicosociological disease: namely that of haphazard or otherwise ethically inappropriate allocation of scarce medical resources. What I have in mind is the term ‘QALY’, which is an acronym standing for quality adjusted life year. Just what this means and what it is intended to do I shall explain in due course. Let me first, however, set the scene.

scholarly journals Cost-Effectiveness of Continuous Positive Airway Pressure Therapy in Patients with Obstructive Sleep Apnea-Hypopnea in British Columbia

2008 ◽  
Vol 15 (3) ◽  
pp. 159-165 ◽  
Author(s):  
MCY Tan ◽  
NT Ayas ◽  
A Mulgrew ◽  
L Cortes ◽  
JM FitzGerald ◽  
...  
Keyword(s):  
Quality Of Life ◽  
British Columbia ◽  
Cost Effectiveness ◽  
Quality Adjusted Life Year ◽  
Third Party ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
The Cost ◽  
Quality Adjusted Life

BACKGROUND: Obstructive sleep apnea-hypopnea (OSAH) is a common disorder characterized by recurrent collapse of the upper airway during sleep. Patients experience a reduced quality of life and an increased risk of motor vehicle crashes (MVCs). Continuous positive airway pressure (CPAP), which is the first-line therapy for OSAH, improves sleepiness, vigilance and quality of life.OBJECTIVE: To assess the cost-effectiveness of CPAP therapy versus no treatment for OSAH patients who are drivers.METHODS: A Markov decision analytical model with a five-year time horizon was used. The study population consisted of male and female patients, between 30 and 59 years of age, who were newly diagnosed with moderate to severe OSAH. The model evaluated the cost-effectiveness of CPAP therapy in reducing rates of MVCs and improving quality of life. Utility values were obtained from previously published studies. Rates of MVCs under the CPAP and no CPAP scenarios were calculated from Insurance Corporation of British Columbia data and a systematic review of published studies. MVCs, equipment and physician costs were obtained from the British Columbia Medical Association, published cost-of-illness studies and the price lists of established vendors of CPAP equipment in British Columbia. Findings were examined from the perspectives of a third-party payer and society.RESULTS: From the third-party payer perspective, CPAP therapy was more effective but more costly than no CPAP (incremental cost-effectiveness ratio [ICER] of $3,626 per quality-adjusted life year). From the societal perspective, the ICER was similar ($2,979 per quality-adjusted life year). The ICER was most dependent on preference elicitation method used to obtain utility values, varying almost sixfold under alternative assumptions from the base-case analysis.CONCLUSION: After considering costs and impact on quality of life, as well as the risk of MVCs in individuals with OSAH, CPAP therapy for OSAH patients is a highly efficient use of health care resources. Provincial governments who do not provide funding for CPAP therapy should reconsider.

Comparison of Hemodialysis and Peritoneal Dialysis — a Cost–Utility Analysis

2002 ◽  
Vol 22 (1) ◽  
pp. 39-47 ◽  
Author(s):  
Karin Sennfält ◽  
Martin Magnusson ◽  
Per Carlsson
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Peritoneal Dialysis ◽  
Kidney Failure ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Age Group ◽  
The Cost ◽  
Quality Adjusted Life

Objective Our aim was to compare both health-related quality of life and costs for hemodialysis (HD) and peritoneal dialysis (PD) in a defined population. Design Decision-tree modeling to estimate total costs and effects for two treatment strategies, HD and PD, among patients with chronic kidney failure, for 5 years following the start of treatment. Courses of events and health-care consumption were mapped in a retrospective matched-record study. Data on health status were obtained from a matched population by a quality-of-life questionnaire (EuroQol). The study has a societal perspective. Setting All dialysis departments in the southeastern health-care region of Sweden. Patients 136 patients with kidney failure, comprising 68 matched pairs, were included in a retrospective record study; 81 patients with kidney failure, comprising 27 matched triplets, were included in a prospective questionnaire study. Main Outcome Measures Cost per life year and cost per quality-adjusted life year. Results The cost per quality-adjusted life year for PD was lower in all analyzed age groups. There was a 12% difference in the age group 21 – 40 years, a 31% difference in the age group 41 – 60 years, and an 11% difference in the age group 61+ years. Peritoneal dialysis and HD resulted in similar frequencies of transplantation (50% and 41%, respectively) and expected survival (3.58 years and 3.56 years, respectively) during the first 5 years after the initiation of treatment. Conclusion The cost–utility ratio is most favorable for PD as the primary method of treatment for patients eligible for both PD and HD.

Economic Evaluation of A Support Program for Caregivers of Demented Elderly

1991 ◽  
Vol 7 (2) ◽  
pp. 209-219 ◽  
Author(s):  
Michael F. Drummond ◽  
E. Ann Mohide ◽  
Michelle Tew ◽  
David L. Streiner ◽  
Dorothy M. Pringle ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Economic Evaluation ◽  
Statistical Significance ◽  
Quality Adjusted Life Year ◽  
Support Program ◽  
Caregiver Support ◽  
Health Care Interventions ◽  
Caregiver Quality ◽  
Quality Adjusted Life

AbstractAn economic evaluation was undertaken concurrently with a randomized trial comparing a Caregiver Support Program (CSP) with existing conventional community nursing care for those caring for elderly relatives at home. The differences in resource consumption were compared with changes in caregiver quality of life, as measured by the Caregiver Quality of Life Instrument (CQLI). A 20% difference from baseline in the CQLI favored the experimental (CSP) group, although this did not reach conventional levels of statistical significance. A comparison of improvement in quality of life with costs implies an incremental cost per quality-adjusted life year gained of Canadian $20,000 for the CSP, which compares favorably with other health care interventions. Further, larger studies are required to confirm this result.

scholarly journals Modern aspects of the study of the quality of life in children with cystic fibrosis

2019 ◽  
Vol 19 (1) ◽  
pp. 43-48
Author(s):  
M. S. Samsonova ◽  
O. I. Simonova ◽  
Irina V. Vinyarskaya
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Pharmacoeconomic Analysis ◽  
Quality Adjusted Life Year ◽  
Therapeutic Approaches ◽  
Health Related ◽  
The One ◽  
Practice Methods ◽  
Quality Adjusted Life

There is presented a review of recent data on the changes in quality of life (QL) in children suffering from cystic fibrosis (CF). The recurrence of acute pulmonary infections was shown to significantly reduce health-related QL. In this aggressive treatment of exacerbations ofpulmonary infection leads to a significant improvement in QL, and to gain in the life expectancy ofpatients with CF. Used in clinical practice methods demonstrate the effectiveness in the short term period, but their impact on health-related QL has not yet been studied. The use of the concept of Quality adjusted life year (QALY) in conjunction with the pharmacoeconomic analysis is the one out of promising directions, which allows in the comparative plan to determine the ratio between cost and effectiveness, safety and QL in alternative schemes of treatment of the disease. The use of the QALY index in the analysis of the CF will allow to execute the cumulative determination as the ratio of "cost-effectiveness", and the influence of the conducted therapy on health-related QL ofpatients, which is an inherent component of the evaluation of the estimation of usefulness of specific therapeutic approaches.

scholarly journals Effects of Metreleptin on Patient Outcomes and Quality of Life in Generalized and Partial Lipodystrophy

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Keziah Cook ◽  
Kelly Adamski ◽  
Aparna Gomes ◽  
Edward Tuttle ◽  
Henner Kalden ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Treatment Options ◽  
Quality Adjusted Life Year ◽  
Reproductive Age ◽  
Partial Lipodystrophy ◽  
The Us ◽  
Before And After ◽  
Subcutaneous Adipose ◽  
Quality Adjusted Life

Abstract Generalized and partial lipodystrophy are rare and complex diseases with progressive clinical and humanistic burdens stemming from selective absence of subcutaneous adipose tissue, which causes reduced energy storage capacity and a deficiency of adipokines such as leptin. Treatment options were limited before leptin replacement therapy (metreleptin) became available. This retrospective study evaluates both clinical and humanistic consequences of the disease and treatment. Chart data were abstracted from a cohort of metreleptin-treated patients with generalized and partial lipodystrophy (n = 112) treated at the US National Institutes of Health. To quantify the quality-of-life consequences of the lipodystrophy disease attributes recorded in chart data, a discrete choice experiment was completed in 6 countries (US, n = 250; EU, n = 750). Resulting utility decrements were used to estimate the quality-adjusted life-year consequences of changes in lipodystrophy attribute prevalence before and after metreleptin. In addition to metabolic impairment, patients with generalized and partial lipodystrophy experienced a range of lipodystrophy consequences, including liver abnormality (94%), hyperphagia (79%), impaired physical appearance (77%), kidney abnormality (63%), reproductive dysfunction (80% of females of reproductive age), and pancreatitis (39%). Improvement was observed in these attributes following initiation of metreleptin. Quality-adjusted life-year gains associated with 12 months of treatment with metreleptin were estimated at 0.313 for generalized and 0.117 for partial lipodystrophy, reducing the gap in quality of life between untreated lipodystrophy and perfect health by approximately 59% and 31%, respectively. This study demonstrates that metreleptin is associated with meaningful clinical and quality-of-life improvements.

scholarly journals The use of Quality-Adjusted Life Years in cost-effectiveness analyses in palliative care: Mapping the debate through an integrative review

2017 ◽  
Vol 31 (4) ◽  
pp. 306-322 ◽  
Author(s):  
Anne B Wichmann ◽  
Eddy MM Adang ◽  
Peep FM Stalmeier ◽  
Sinta Kristanti ◽  
Lieve Van den Block ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cost Effectiveness ◽  
Quality Adjusted Life Year ◽  
Integrative Review ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Pros And Cons ◽  
Quality Adjusted Life

Background: In cost-effectiveness analyses in healthcare, Quality-Adjusted Life Years are often used as outcome measure of effectiveness. However, there is an ongoing debate concerning the appropriateness of its use for decision-making in palliative care. Aim: To systematically map pros and cons of using the Quality-Adjusted Life Year to inform decisions on resource allocation among palliative care interventions, as brought forward in the debate, and to discuss the Quality-Adjusted Life Year’s value for palliative care. Design: The integrative review method of Whittemore and Knafl was followed. Theoretical arguments and empirical findings were mapped. Data sources: A literature search was conducted in PubMed, EMBASE, and CINAHL, in which MeSH (Medical Subject Headings) terms were Palliative Care, Cost-Benefit Analysis, Quality of Life, and Quality-Adjusted Life Years. Findings: Three themes regarding the pros and cons were identified: (1) restrictions in life years gained, (2) conceptualization of quality of life and its measurement, including suggestions to adapt this, and (3) valuation and additivity of time, referring to changing valuation of time. The debate is recognized in empirical studies, but alternatives not yet applied. Conclusion: The Quality-Adjusted Life Year might be more valuable for palliative care if specific issues are taken into account. Despite restrictions in life years gained, Quality-Adjusted Life Years can be achieved in palliative care. However, in measuring quality of life, we recommend to—in addition to the EQ-5D— make use of quality of life or capability instruments specifically for palliative care. Also, we suggest exploring the possibility of integrating valuation of time in a non-linear way in the Quality-Adjusted Life Year.

scholarly journals Could the choice of patient versus proxy ratings for assessing quality of life in dementia affect resource allocation in health care?

2012 ◽  
Vol 13 (1) ◽  
pp. 25-31
Author(s):  
Jenny Alwin ◽  
Thor-Henrik Brodtkorb
Keyword(s):  
Quality Of Life ◽  
Resource Allocation ◽  
Substantial Effect ◽  
Quality Adjusted Life Year ◽  
Published Data ◽  
Model Of Alzheimer’S Disease ◽  
Patient Health ◽  
Related Quality ◽  
Health Related

OBJECTIVE: The aim of this paper is to demonstrate how the choice of patient versus proxy ratings of patient health-related quality of life (HRQoL) in dementia, for use in cost-effectiveness analyses (CEAs), could potentially affect resource allocation in health care.METHODS:A model of Alzheimer’s disease (AD) based on cognitive ability was used to assess the consequences of using HRQoL ratings from either patients themselves or proxies if a new treatment was to be introduced. The model was based on previously published data on costs related to AD stages as well as HRQoL ratings from AD patients and from their caregivers as proxy raters.RESULTS:The results show that there can be large differences in the results of the CEAs depending on whether the ratings of patients’ HRQoL were made by the patients themselves or by the proxy. When patient self-ratings of HRQoL were used, the cost/quality-adjusted life year (QALY) gained was much higher as compared to the scenario when proxy ratings were used for the same analysis.CONCLUSIONS: The choice of patient self-ratings compared to proxy ratings of patients’ HRQoL can have a substantial effect on the results of CEAs. These differences in results may have an important impact on decision making and, ultimately, on resource allocation. In order to critically appraise the results of CEA studies in dementia we advise that both patient and proxy ratings are used in the CEA. To decide on methodology it is of great importance that focus is directed towards determining the most valid way to measure HRQoL in AD.

Sign in / Sign up

Export Citation Format

Share Document