Economics, health and health economics: HYEs (healthy-years equivalent) versus QALYs (quality-adjusted live-year)
This paper responds to Culyer and Wagstaff's (CW) and Buckingham's (B) arguments. We refute their claim about the equivalence of HYEs and QALYs; they fail to distinguish between choice under uncertainty and under certainty. CW assume that all individuals have a specific form of utility function, which yields their conclusion of equivalence. B's arguments confuse the measurement technique and the utility theory from which it stems; his argument about the normative superiority of the QALY construct is inconsistent with economic thinking. The HYE, by being compatible with the principles of economics, is superior to the QALY for economic evaluations of health care interventions.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
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Gafni
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Birch
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Mehrez
D002170:Canada; D002755:Choice Behavior; D003258:Consumer Behavior / Q000191:economics; D003362:Cost-Benefit Analysis / Q000379:methods; D004470:Economics, Medical; D006801:Humans; D017059:Models, Econometric; D017063:Outcome Assessment, Health Care / Q000191:economics*; D011788:Quality of Life; D013997:Time Factors; D026712:Value of Life