scholarly journals Valuing Health for Clinical and Economic Decisions: Directions Relevant for Rheumatologists

2011 ◽  
Vol 38 (8) ◽  
pp. 1770-1775 ◽  
Author(s):  
MARK J. HARRISON ◽  
NICK J. BANSBACK ◽  
CARLO A. MARRA ◽  
MICHAEL DRUMMOND ◽  
PETER S. TUGWELL ◽  
...  
Keyword(s):  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Point Of View ◽  
Health State ◽  
Utility Analysis ◽  
Economic Decisions ◽  
Pros And Cons ◽  
Allocation Decisions ◽  
Qaly Approach ◽  
Quality Adjusted Life

The quality-adjusted life-year (QALY) is a construct that integrates the value or preference for a health state over the period of time in that health state. The main use of QALY is in cost-utility analysis, to help make resource allocation decisions when faced with choices. Although the concept of the QALY is appealing, there is ongoing debate regarding their usefulness and approaches to deriving QALY. In 2008, OMERACT engaged in an effort to agree on QALY approaches that can be used in rheumatology. Based on a Web questionnaire and a subsequent meeting, rheumatologists questioned whether it was relevant for OMERACT (1) to investigate use of a QALY that represents the patients’ perspective, (2) to explore the validity of the visual analog scale (VAS) to value health, and (3) to understand the validity of mapping health-specific instruments on existing preference instruments. This article discusses the pros and cons of these points in light of current insight from the point of view of health economics and decision-making theory. It also considers the further research agenda toward a QALY approach in rheumatology.

A Cost-Utility Analysis of Abdominal Hysterectomy Versus Transcervical Endometrial Resection for the Surgical Treatment of Menorrhagia

1998 ◽  
Vol 14 (2) ◽  
pp. 302-319 ◽  
Author(s):  
Mark Sculpher
Keyword(s):  
Cost Effective ◽  
Abdominal Hysterectomy ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Health State ◽  
Utility Analysis ◽  
Major Health ◽  
Parameter Values ◽  
Quality Adjusted Life

AbstractMenorrhagia, or heavy regular menstrual bleeding, represents a major health burden to women. Trials comparing abdominal hysterectomy (AH) with transcervical resection of the endometrium (TCRE) for the condition have shown that, although the duration and severity of convalescence is less with TCRE, AH produces a permanent solution to heavy bleeding while TCRE fails in a proportion of women by 2 years. However, by 2 years, TCRE costs only 71% that of AH. This paper presents a cost-utility analysis to assess which procedure is more cost-effective overall. Under most plausible parameter values and on the basis of health state values elicited from a sample of women with menorrhagia, AH is likely to be considered more cost-effective than TCRE if purchasers are willing to pay an additional cost of at least £6,500 per extra quality-adjusted life-year generated by AH.

scholarly journals A one-year cost–utility analysis of REBOA versus RTACC for non-compressible torso haemorrhage

Trauma ◽  
2017 ◽  
Vol 21 (1) ◽  
pp. 45-54 ◽  
Author(s):  
Maxwell S Renna ◽  
Cristiano van Zeller ◽  
Farah Abu-Hijleh ◽  
Cherlyn Tong ◽  
Jasmine Gambini ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Cost Effectiveness Ratio ◽  
One Year ◽  
Quality Adjusted Life

Introduction Major trauma is a leading cause of death and disability in young adults, especially from massive non-compressible torso haemorrhage. The standard technique to control distal haemorrhage and maximise central perfusion is resuscitative thoracotomy with aortic cross-clamping (RTACC). More recently, the minimally invasive technique of resuscitative endovascular balloon occlusion of the aorta (REBOA) has been developed to similarly limit distal haemorrhage without the morbidity of thoracotomy; cost–utility studies on this intervention, however, are still lacking. The aim of this study was to perform a one-year cost–utility analysis of REBOA as an intervention for patients with major traumatic non-compressible abdominal haemorrhage, compared to RTACC within the U.K.’s National Health Service. Methods A retrospective analysis of the outcomes following REBOA and RTACC was conducted based on the published literature of survival and complication rates after intervention. Utility was obtained from studies that used the EQ-5D index and from self-conducted surveys. Costs were calculated using 2016/2017 National Health Service tariff data and supplemented from further literature. A cost–utility analysis was then conducted. Results A total of 12 studies for REBOA and 20 studies for RTACC were included. The mean injury severity scores for RTACC and REBOA were 34 and 39, and mean probability of death was 9.7 and 54%, respectively. The incremental cost-effectiveness ratio of REBOA when compared to RTACC was £44,617.44 per quality-adjusted life year. The incremental cost-effectiveness ratio, by exceeding the National Institute for Health and Clinical Effectiveness’s willingness-to-pay threshold of £30,000/quality-adjusted life year, suggests that this intervention is not cost-effective in comparison to RTACC. However, REBOA yielded a 157% improvement in utility with a comparatively small cost increase of 31.5%. Conclusion Although REBOA has not been found to be cost-effective when compared to RTACC, ultimately, clinical experience and expertise should be the main factor in driving the decision over which intervention to prioritise in the emergency context.

COST-UTILITY ANALYSIS OF THE CYBERKNIFE SYSTEM FOR METASTATIC SPINAL TUMORS

Neurosurgery ◽  
2009 ◽  
Vol 64 (suppl_2) ◽  
pp. A73-A83 ◽  
Author(s):  
Frank J. Papatheofanis ◽  
Erin Williams ◽  
Steven D. Chang
Keyword(s):  
Radiation Therapy ◽  
Quality Adjusted Life Year ◽  
External Beam Radiation Therapy ◽  
Cost Utility ◽  
External Beam Radiation ◽  
Spinal Tumors ◽  
External Beam ◽  
Utility Analysis ◽  
Beam Radiation ◽  
Quality Adjusted Life

Abstract OBJECTIVE Using decision analysis, a cost-utility study evaluated the cost-effectiveness of CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) in comparison to external beam radiation therapy in the treatment of metastatic spinal malignancies. METHODS The published literature provided evidence on the effectiveness of the comparator interventions in the absence of primary outcomes data. Costs of care were derived from Centers for Medicare and Medicaid Services fee schedules. A Markov model was constructed from the payer perspective to simulate the outcomes of patients undergoing nonchemotherapeutic interventions for metastatic spinal tumors. Because cancer therapies bear significant health and economic consequences, the impact of treatment-related toxicities was integrated into the model. Given the terminal nature of these conditions and the limited life expectancy of the patient population, the time horizon for the analysis was limited to 12 months. RESULTS Patients treated with CyberKnife SRS gained an additional net health benefit of 0.08 quality-adjusted life year; the calculated cost of CyberKnife SRS was $1933 less than external beam radiation therapy for comparable effectiveness. The incremental cost per benefit for this strategy ($41 500 per quality-adjusted life year) met payers' willingness-to-pay criteria. CONCLUSION Cost-utility analysis demonstrated that CyberKnife SRS was a superior, cost-effective primary intervention for patients with metastatic spinal tumors compared with conventional external beam radiation therapy.

scholarly journals ANALISIS NILAI WILLINGNESS TO PAY PER QUALITY ADJUSTED LIFE YEAR TERAPI PENYAKIT MODERATE MASYARAKAT DI KOTA BANJARMASIN TAHUN 2019

2020 ◽  
Vol 4 (1) ◽  
pp. 1-11
Author(s):  
Melviani ◽  
Setia Budi
Keyword(s):  
Willingness To Pay ◽  
Stated Preference ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Cross Sectional ◽  
Bivariate Correlation ◽  
Life Years ◽  
Quality Adjusted Life

Pelayanan kesehatan di Indonesia belum maksimal dalam memenuhi kebutuhan pasien dengan penyakit moderate. Pendekatan farmakoekonomi yang paling direkomendasikan dalam rangka kendali mutu dan biaya adalah cost utility analysis. Interpretasi terhadap nilai rasio efektivitas biaya tersebut membutuhkan cost effectiveness threshold untuk menentukan suatu teknologi kesehatan bersifat costeffective atau tidak. Salah satu pendekatan yang dapat dilakukan adalah dengan estimasi nilai willingness to pay per quality adjusted life years. Tujuan penelitian adalah menganalisis nilai estimasi willingness to pay per quality adjusted life year pada penyakit moderate di masyarakat di Kota Banjarmasin dan faktor-faktor yang mempengaruhi WTP per QALY. Metode penelitian menggunakan pendekatan cross-sectional. Survei dilakukan pada masyarakat di Kota Banjarmasin tahun 2019 menggunakan metode stated preference dengan pendekatan contingent valuation. Jumlah sampel sebanyak 100 responden. Instrumen penelitian ini berupa kuesioner yang terdiri dari pengukuran nilai WTP menggunakan metode dichotomous bidding game, pengukuran utility menggunakan EQ-5D berdasarkan skenario hipotetik nilai utility penyakit moderate. Analisis mengunakan bivariate correlation analysis spearman.  Hasil penelitian menunjukan Rata-rata WTP per QALY EQ-5D-5L Rp19.538.910 dan analisis variabel karakteristik responden terhadap WTP per QALY di dapatkan R square 0,397(p=0,026) yang artinya bahwa 39% secara bersama-sama variabel dependen akan mempengaruhi WTP per QALY. Penelitian ini diharapkan dapat memberi masukan terhadap CE-Threshold berdasarkan preferensi masyarakat

Cost-Utility Analysis of Group Living in Dementia Care

1995 ◽  
Vol 11 (1) ◽  
pp. 49-65 ◽  
Author(s):  
Anders Wimo ◽  
Bengt Mattson ◽  
Ingvar Krakau ◽  
Tua Eriksson ◽  
Anders Nelvig ◽  
...  
Keyword(s):  
Group Living ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Dementia Patients ◽  
Methodological Problems ◽  
Institutionalized Patients ◽  
The Cost ◽  
Quality Adjusted Life

AbstractA cost-utility analysis (CUA) was applied to group living for dementia patients. A Markov-model of an expected life-length of 8 years was used. Forty-six patients in group living were compared to 39 patients living at home by inclusion and 23 institutionalized patients. When the cost per gained quality-adjusted life-year (QALY) was calculated, the group living alternative was the most favorable for the patients, giving a cost per paired QALY of US dollars > 0. In the extensive sensitivity analysis the main result was consistent but methodological problems were indicated.

Cost–utility analysis of an integrated genetic/epigenetic test for assessing risk for coronary heart disease

Epigenomics ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 531-547 ◽  
Author(s):  
Younsoo Jung ◽  
David Frisvold ◽  
Timur Dogan ◽  
Meeshanthini Dogan ◽  
Rob Philibert
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cost Effectiveness ◽  
Healthcare Spending ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Potential Impact ◽  
Quality Adjusted Life

Aim: New epigenetically based methods for assessing risk for coronary heart disease may be more sensitive but are generally more costly than current methods. To understand their potential impact on healthcare spending, we conducted a cost–utility analysis. Methods: We compared costs using the new Epi + Gen CHD™ test with those of existing tests using a cohort Markov simulation model. Results: We found that use of the new test was associated with both better survival and highly competitive negative incremental cost–effectiveness ratios ranging from -$42,000 to -$8000 per quality-adjusted life year for models with and without a secondary test. Conclusion: The new integrated genetic/epigenetic test will save money and lives under most real-world scenarios. Similar advantages may be seen for other epigenetic tests.

Utilities and Quality-Adjusted Life Years

1989 ◽  
Vol 5 (4) ◽  
pp. 559-575 ◽  
Author(s):  
George W. Torrance ◽  
David Feeny
Keyword(s):  
Quality Of Life ◽  
Cost Utility ◽  
Health Improvement ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Quality Adjustment ◽  
Life Years ◽  
Quality Adjusted Life ◽  
Broad Overview

Utilities and quality-adjusted life years (QALYs) are reviewed, with particular focus on their use in technology assessment. This article provides a broad overview and perspective on these two techniques and their interrelationship, with reference to other sources for details of implementation. The historical development, assumptions, strengths/weaknesses, and applications of each are summarized.Utilities are specifically designed for individual decision-making under uncertainty, but, with additional assumptions, utilities can be aggregated across individuals to provide a group utility function. QALYs are designed to aggregate in a single summary measure the total health improvement for a group of individuals, capturing improvements from impacts on both quantity of life and quality of life– with quality of life broadly defined. Utilities can be used as the quality-adjustment weights for QALYs; they are particularly appropriate for that purpose, and this combination provides a powerful and highly useful variation on cost-effectiveness analysis known as cost-utility analysis.

scholarly journals Measurement, modeling and QALYs

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1048
Author(s):  
Paul C. Langley ◽  
Stephen P. McKenna
Keyword(s):  
Quality Adjusted Life Year ◽  
Response To Therapy ◽  
Value Assessment ◽  
Scaling Properties ◽  
Ratio Scales ◽  
Utility Scale ◽  
Allocation Decisions ◽  
Inform Resource Allocation ◽  
Quality Adjusted Life ◽  
Utility Measures

Over the past 30 years, a mainstay of health technology assessment has been the creation of modeled incremental cost-per-quality adjusted life year (QALY) claims. These are intended to inform resource allocation decisions. Unfortunately, the reliance on the construction of QALYs from generic utility scales is misplaced. Those advocating QALY-based lifetime modeled claims fail to appreciate the limitations placed on these constructs by the axioms of fundamental measurement. Utility scales, such as those created by the EQ-5D-3L instrument, are nothing more than multidimensional, ordinal scales. Such scales cannot support basic arithmetic operations. Interval scales can support addition and subtraction; ratio scales the further operations of multiplication and division. Those who advocate the construction of QALYs fail to appreciate that such an operation is only possible if the utility scale is unidimensional and has ratio properties with a true zero. The utility measures available do not meet these requirements. As we cannot produce meaningful utility values, the QALY is an invalid construct. Consequently, cost-per-incremental QALY claims are impossible to sustain and the application of cost-per QALY thresholds meaningless. As utility is a latent, unidimensional variable, the best a measure of utility could achieve would be unidimensionality and interval scaling properties. Where such measures are available, they could support claims for response to therapy. Consequently, there would be no need to continue constructing imaginary lifetime value assessment frameworks. Admitting that the QALY is a fatally flawed construct means rejecting 30 years of cost-per-QALY models.

scholarly journals Imaginary Worlds: The Status of Modeled Quality Adjusted Life Year Claims for New Oral Anticoagulants in Atrial Fibrillation Published Between January 2012 and February 2016

2016 ◽  
Vol 7 (3) ◽  
Author(s):  
Paul C Langley ◽  
Taeho Greg Rhee
Keyword(s):  
Lifetime Cost ◽  
Oral Anticoagulants ◽  
Empirical Evaluation ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
New Oral Anticoagulants ◽  
Normal Science ◽  
The Status ◽  
The Uk ◽  
Quality Adjusted Life

The purpose of this commentary is to evaluate modeled quality adjusted life year claims (QALYs) for new oral anticoagulants (NOACs) published in the period from January 2012 to February 2016. The focus of this commentary is to assess whether or not the modeled claims meet the standards of normal science in supporting falsification and replication. A systematic and consensus review by the authors identified a total of 23 cost-utility NOACs evaluations along with four single technology appraisals undertaken by the National Institute for Health and Care Excellence (NICE) in the UK. Each study was evaluated in terms of four criteria: (i) did the study generate evaluable claims (ii) id the authors attempt to generate evaluable claims (iii) did the authors suggest how the claims might be evaluated and (iv) did the authors caution readers as to the implications of generating non-evaluable projections or claims for credibility in health system decision making? None of the 23 studies assessed or the four NICE single technology appraisals met any of the four assessment criteria. None of the studies presented projections or claims in a form suitable for empirical evaluation. None could support falsification or replication. They failed the standards associated with the scientific method. Failure to meet the standards of normal science meant that the studies, from a formulary assessment perspective, are not credible. The claims made were either impossible to verify, or if potentially verifiable, were not presented in a testable form. There was no basis for assessing whether the claims were right or even if they were wrong. This lack of scientific credibility is a major concern. In particular, the choice of a lifetime cost-utility framework for assessing the NOACs against warfarin and against each other effectively precludes any experimental assessment. If medical economics is to advance through the formulation and testing of hypotheses, then editors of journals should consider whether or not to set standards for the acceptance of publications to include the requirement for testable claims and the results of claims assessment. If this is not acceptable, then it should be made clear that published modeled claims and simulations are simply imaginary worlds or thought experiments. Editors cannot sit back and assume that at some time in the future non-testable projections will possibly be evaluated. Conflict of Interest None   Type: Commentary

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