title: Palliative care for the terminally ill in America: the consideration of QALYs, costs, and ethical issues.
abstract: The drive for cost-effective use of medical interventions has advantages, but can also be challenging in the context of end-of-life palliative treatments. A quality-adjusted life-year (QALY) provides a common currency to assess the extent of the benefits gained from a variety of interventions in terms of health-related quality of life and survival for the patient. However, since it is in the nature of end-of-life palliative care that the benefits it brings to its patients are of short duration, it fares poorly under a policy of QALY-maximization. Nevertheless, we argue that the goals of palliative care and QALY are not incompatible, and optimal integration of palliative care into the calculation of QALY may reveal a mechanism to modify considerations of how optimal quality of life can be achieved, even in the face of terminal illness. The use of QALYs in resource allocation means that palliative care will always compete with alternative uses of the same money. More research should be conducted to evaluate choices between palliative care and more aggressive therapies for the terminally ill. However, current limited data show that investing in palliative care makes more sense not only ethically, but also financially.
authors.affiliation: Department of Health Administration and Policy, George Mason University, MS: 1J3, 4400 University Drive, Fairfax, VA 22030-4444, USA. ytyang@gmu.edu
authors.forename: Y Tony
authors.initials: YT
authors.lastname: Yang
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Mahon
mesh_terms: D003362:Cost-Benefit Analysis; D028663:Ethical Theory; D015276:Health Care Rationing / Q000191:economics / Q000941:ethics / Q000379:methods; D006291:Health Policy; D017051:Hospice Care / Q000191:economics / Q000941:ethics; D006801:Humans; D010166:Palliative Care / Q000191:economics* / Q000941:ethics*; D011639:Public Opinion; D019057:Quality-Adjusted Life Years; D012935:Social Justice; D019452:Terminally Ill; D014481:United States
references.citation: Ann Intern Med. 2008 Jan 15;148(2):147-59
references.pmid: 18195339
references.citation: Ann Intern Med. 2008 Jan 15;148(2):141-6
references.pmid: 18195338
references.citation: Nurs Philos. 2008 Apr;9(2):110-20
references.pmid: 18336708
references.citation: Arch Intern Med. 2002 Aug 12-26;162(15):1722-8
references.pmid: 12153375
references.citation: Perspect Biol Med. 2006 Winter;49(1):10-8
references.pmid: 16489273
references.citation: Arch Intern Med. 2009 Mar 9;169(5):480-8
references.pmid: 19273778
references.citation: J Palliat Med. 2005;8 Suppl 1:S12-21
references.pmid: 16499460
references.citation: N Engl J Med. 2010 Aug 19;363(8):781-2
references.pmid: 20818881
references.citation: J Pain Symptom Manage. 2009 Jul;38(1):62-7
references.pmid: 19615628
references.citation: Soc Sci Med. 1989;28(4):299-308
references.pmid: 2649989
references.citation: Arch Intern Med. 2008 Sep 8;168(16):1783-90
references.pmid: 18779466
references.citation: N Engl J Med. 2007 Nov 1;357(18):1793-5
references.pmid: 17978287
references.citation: N Engl J Med. 2010 Aug 19;363(8):733-42
references.pmid: 20818875
references.citation: BMJ. 2000 Nov 25;321(7272):1300-1
references.pmid: 11090498
references.citation: Health Care Anal. 2005 Dec;13(4):289-301
references.pmid: 16435466