[Cost-utility analysis as a mechanism for allocation of health care resources: a review of the debate].
Priority setting in health care involves choosing between alternative health care programs and/or patients or groups of patients who will receive care. Traditionally, health economists have proposed maximizing the additional health gain measured in QALYs as a way of setting priorities and maximizing social welfare. This requires that the social value from health improvements be a product of gains in years of life, quality of life, and number of people treated. The results of a literature review suggest that potential health gain is not a single relevant determinant of value, nor is the rule of maximizing this gain sufficient. The social value of a health gain appears not to be linear in terms of mortality and morbidity, or neutral vis-à-vis people's characteristics or the ultimate distribution of health in society. In parallel with the review of the debate on the role and limitation of QALYs for prioritizing health care resources, the article attempts to justify the controversy over some empirical results, particularly in relation to the construction and expression of social preferences.
Pinho
Micaela Moreira
MM
Faculdade de Ciências Econômicas e da Empresa, Universidade Lusíada, Porto, Portugal. michaelapinho@hotmail.com
Veiga
Paula Alexandra Correia Veloso
PA
D003365:Costs and Cost Analysis; D015276:Health Care Rationing / Q000191:economics / Q000458:organization & administration*; D006292:Health Priorities / Q000191:economics / Q000458:organization & administration*; D006297:Health Services Accessibility; D006801:Humans; D019057:Quality-Adjusted Life Years