Improving value measurement in cost-effectiveness analysis.
OBJECTIVE
Before cost-effectiveness analysis (CEA) can fulfill its promise as a tool to guide health care allocation decisions, the method of incorporating societal values into CEA may need to be improved.


METHODS
The study design was a declarative exposition of potential fallacies in the theoretical underpinnings of CEA. Two values held by many people-preferences for giving priority to severely ill patients and preferences to avoid discrimination against people who have limited treatment potential because of disability or chronic illness-that are not currently incorporated into CEA are discussed.


CONCLUSIONS
Traditional CEA, through the measurement of quality-adjusted life years (QALYs), is constrained because of a "QALY trap." If, for example, saving the life of a person with paraplegia is equally valuable as saving the life of a person without paraplegia, then current QALY methods force us to conclude that curing paraplegia brings no benefit. Basing cost-effectiveness measurement on societal values rather than QALYs may allow us to better capture public rationing preferences, thereby escaping the QALY trap. CEA can accommodate a wider range of such societal values about fairness in its measurements by amending its methodology.
Ubel
P A
PA
Veterans Affairs Medical Center and Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA.
Nord
E
E
Gold
M
M
Menzel
P
P
Prades
J L
JL
Richardson
J
J
D001294:Attitude to Health; D002908:Chronic Disease; D003362:Cost-Benefit Analysis / Q000379:methods; D006233:Persons with Disabilities; D015276:Health Care Rationing; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods*; D011287:Prejudice; D019057:Quality-Adjusted Life Years; D012945:Social Values; D014481:United States; D026712:Value of Life