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- W2052391811 abstract "A problem in health program evaluation is to find a common denominator with respect to which the consequences of programs with diverse objectives and clinical endpoints may be compared. The monetary solution in costbenefit analysis has slowly given way to the use of the quality-adjusted life year (QALY) as the denominator of a cost-effectiveness (or cost-utility) ratio that can be used to compare the efficiency with which diverse programs use resources to produce health. Implicit in this use of the QALY as the common denominator is the judgment that the QALY is, indeed, a measure of health, as valued from the perspective of the resource-allocating decision maker. Donaldson et al. (1988) argue that QALY scales developed for a particular context, such as long-term care, are more ‘sensitive’ than scales designed to be applicable to a wide range of programs. They define sensitivity as the ability of the scale to detect statistically meaningful differences between health states. They do not comment, however, on whether these more ‘sensitive’ scales are valid as QALY scales for purposes of program evaluation; that is, whether the QALYs they produce reflect the values of the decision maker (e.g., of the society). A QALY is a unit on a value function scale (or, for decisions under uncertainty, on a utility scale). Ten years at a quality of 0.5 are judged equivalent to live years at a quality of 1.0. Can this be said of the Life Satisfaction Index? Are ten years with an LSI score of 20 no better than five years with an LSI score of 40? Perhaps some mathematical transformation of the LSI scale would have this property, but previous research has shown that categorical scales not based on explicit time-tradeoff or standard-gamble questions tend to overvalue diminutions in quality relative to death [Torrance (1976)]. The Rosser-Kind scale cited in the article has more face validity as a proper QALY scale for resource-allocation purposes, since it" @default.
- W2052391811 created "2016-06-24" @default.
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- W2052391811 date "1988-09-01" @default.
- W2052391811 modified "2023-10-18" @default.
- W2052391811 title "A QALY is a QALY is a QALY — Or is it?" @default.
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- W2052391811 doi "https://doi.org/10.1016/0167-6296(88)90030-6" @default.
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