Dataset Information

Setting Dead at Zero: Applying Scale Properties to the QALY Model.

ABSTRACT:

Introduction

Scaling severe states can be a difficult task. First, the method of measurement affects whether a health state is considered better or worse than dead. Second, in discrete choice experiments, different models to anchor health states on 0 (dead) and 1 (perfect health) produce varying amounts of health states worse than dead.

Research question

Within the context of the quality-adjusted life year (QALY) model, this article provides insight into the value assigned to dead and its consequences for decision making. Our research questions are 1) what are the arguments set forth to assign dead the number 0 on the health-utility scale? And 2) what are the effects of the position of dead on the health-utility scale on decision making?

Methods

A literature review was conducted to explore the arguments set forth to assign dead a value of 0 in the QALY model. In addition, scale properties and transformations were considered.

Results

The review uncovered several practical and theoretical considerations for setting dead at 0. In the QALY model, indifference between 2 health episodes is not preserved under changes of the origin of the duration scale. Ratio scale properties are needed for the duration scale to preserve indifferences. In combination with preferences and zero conditions for duration and health, it follows that dead should have a value of 0.

Conclusions

The health-utility and duration scales have ratio scale properties, and dead should be assigned the number 0. Furthermore, the position of dead should be carefully established, because it determines how life-saving and life-improving values are weighed in cost-utility analysis.

SUBMITTER: Roudijk B

PROVIDER: S-EPMC6587359 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Publications

Setting Dead at Zero: Applying Scale Properties to the QALY Model.

Roudijk Bram B Donders A Rogier T ART Stalmeier Peep F M PFM

Medical decision making : an international journal of the Society for Medical Decision Making 20180409 6

<h4>Introduction</h4>Scaling severe states can be a difficult task. First, the method of measurement affects whether a health state is considered better or worse than dead. Second, in discrete choice experiments, different models to anchor health states on 0 (dead) and 1 (perfect health) produce varying amounts of health states worse than dead.<h4>Research question</h4>Within the context of the quality-adjusted life year (QALY) model, this article provides insight into the value assigned to dead ...[more]

PMID: 29629848

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Project description:BackgroundMultiple principles are relevant in priority setting, two of which are often considered particularly important. According to the greater benefit principle, resources should be directed toward the intervention with the greater health benefit. This principle is intimately linked to the goal of health maximization and standard cost-effectiveness analysis (CEA). According to the worse off principle, resources should be directed toward the intervention benefiting those initially worse off. This principle is often linked to an idea of equity. Together, the two principles accord with prioritarianism; a view which can motivate non-standard CEA. Crucial for the actual application of prioritarianism is the trade-off between the two principles, and this trade-off has received scant attention when the worse off are specified in terms of lifetime health. This paper sheds light on that specific trade-off and on the public support for prioritarianism by providing fresh empirical evidence and by clarifying the close links between the findings and normative theory.MethodsA new, self-administered, computer-based questionnaire was used, to which 96 students in Norway responded. How respondents wanted to balance quality-adjusted life years (QALYs) gained against benefiting those with few lifetime QALYs was quantified for a range of different cases.ResultsRespondents supported both principles and were willing to make trade-offs in a particular way. In the baseline case, the median response valued a QALY 3.3 and 2.5 times more when benefiting someone with lifetime QALYs of 10 and 25 rather than 70. Average responses harbored fundamental disagreements and varied modestly across distributional settings.ConclusionIn the specific context of lifetime health, the findings underscore the insufficiency of pure QALY maximization and explicate how people make trade-offs in a way that can help operationalize lifetime prioritarianism and non-standard CEA. Seen through the lens of normative theory, the findings highlight key challenges for prioritarianism applied to priority setting.

Dataset Information

Setting Dead at Zero: Applying Scale Properties to the QALY Model.

Introduction

Research question

Methods

Results

Conclusions

Publications

Setting Dead at Zero: Applying Scale Properties to the QALY Model.

Similar Datasets

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