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Do quality-adjusted life years take account of lost income? Evidence from an Australian survey

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Abstract

The procedures used in cost utility analysis for eliciting quality of life weights have generally omitted any instruction concerning the level of consumption in a health state, despite the fact that some health states preclude the possibility of normal employment. This introduces ambiguity into the interpretation of quality of life (QoL) scores, and project ranking is sensitive to the subsequent treatment of consumption in the analysis. This article reports the results of a study that questioned 131 respondents to a time trade-off (TTO) interview about their assumptions concerning consumption and the amount of thought given to consumption. Results indicate that, without prompting, most assumed unchanged consumption, implying little bias in existing studies.

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Notes

  1. The VisQoL consists of 26 items and seven dimensions, namely vision and six AQoL dimensions (independent living, mental well-being, pain, family and social, coping and senses). See Hawthorne et al. [7, 18].

  2. The conclusion by Weinstein et al. would be correct if QALYs were (should be) monetised in a way that resulted in the perfect (market) valuation of QALYs. In this case if DC = direct cost, the net cost per QALY (excluding consumption), i.e., (DC − C)/(QALY − C), and the full direct cost per QALY assuming consumption, i.e., DC/QALY, would result in the same net present value (DC − QALY) where QALYs subsume consumption. However, as illustrated in Table 4, this result breaks down when QALYs are not measured in this way.

  3. With QALYs valued at $800 the QALY gains from service A and service B would be 0.4 + 80/800 = 0.5 and 0.1 + 100/800 = 0.225, respectively. If procedures 1 and 2 were used, the net present value of the services would be $400 and $180, respectively.

  4. Illustrating this, in the previous arithmetic example (footnote 3), the QALY value of service A would exceed 1.00 after treatment.

References

  1. Brouwer, W.B., Koopmanschap, M.A.: On the economic foundations of CEA. Ladies and gentlemen, take your positions! J. Health Econ. 19, 439–459 (2000)

    Article  Google Scholar 

  2. Brouwer, W.B., Koopmanschap, M.A., Rutten, F.F.: Productivity costs means through quality of life? A response to the recommendation of the Washington Panel. Health Econ. 6, 253–259 (1997)

    Article  Google Scholar 

  3. Brouwer, W.B., Koopmanschap, M.A., Rutten, F.F.: Productivity costs in cost-effectiveness analysis: numerator or denominator: a further discussion. Health Econ. 6, 511–514 (1997)

    Article  Google Scholar 

  4. Brouwer, W.B., Rutten, F.F.: The missing link: on the line between C and E. Econ. Eval. 12, 629–636 (2003)

    Google Scholar 

  5. Dowie, J.A.: Valuing the benefits of health improvement. Aust. Econ. Pap. 9(14), 21–41 (1970)

    Article  Google Scholar 

  6. Gold M.R., Siegel J.E., Russell L.B., Weinstein M.C.: Cost effectiveness in health and medicine. Oxford University Press, Oxford (1996)

    Google Scholar 

  7. Hawthorne, G., Richardson J, Day, N.A.: A comparison of the assessment of quality of life (AQoL) with four other generic utility instruments. Ann. Med. 33(5), 358–370 (2001)

    Article  Google Scholar 

  8. Johannesson M.: Avoiding double counting in pharmacoeconomic studies. Pharmacoeconomics 11, 385–388 (1997)

    Article  Google Scholar 

  9. Johannesson, M., Karlsson, G.: The friction cost method: a comment. J. Health Econ. 16, 249–256 (1997)

    Article  Google Scholar 

  10. Koopmanschap, M., Rutten, F.F., van Ineveld, B.M., van Roijen L.: The friction cost method for measuring indirect costs of disease. J. Health Econ. 14, 171–189 (1995)

    Article  Google Scholar 

  11. Krol, M., Brouwer, W., Sendi P.: Productivity cost in health state valuations: does explicit instruction matter. Pharmacoeconomics 24(4), 401 (2006)

    Article  Google Scholar 

  12. Meltzer, D., Weckerle C., Chang, L.M.: Do people consider financial effects in answering quality of life questions. Med. Decis. Making 19, 517 (1999)

    Article  Google Scholar 

  13. Misajon, R., Hawthorne, G., Richardson, J., Barton, J., Peacock, S., Iezzi A., Keeffe J: Vision and Quality of Life: The Development of a Utility Measure. Invest. Ophthalmol. Vis. Sci. 46, 4007–4015 (2005)

  14. Myers, J., McCabe, S., Gohmann S: Quality-of-life-assessment when there is a loss of income. Med. Decis. Making, 27, 27–33 (2007)

    Google Scholar 

  15. Olsen, J.A., Richardson J.: Production gains from health care: what should be included in cost-effectiveness analyses? Soc. Sci. Med. 49, 17–26 (1999)

    Article  Google Scholar 

  16. Peacock, S., Misajon, R., Iezzi, A., Richardson, J., Hawthorne, G., Keeffe J.: Vision and quality of life: development of methods for the VisQoL vision related utility instrument. Ophthalmic Epidemiol. (2008, in press)

  17. Richardson, J.: Economic assessment of health care: theory in practice. Aust. Econ. Rev. 1, 4–21 (1991)

    Article  Google Scholar 

  18. Richardson, J., Day, N.A., Peacock, S., Iezzi, A.: Measurement of quality of life for economic evaluation and the assessment of quality of life (AQoL) mark II instrument. Aust. Econ. Rev. 37, 62–88 (2004)

    Article  Google Scholar 

  19. Sendi, P., Brouwer, W.B.F.: Is silence golden? A test of the incorporation of the effects of ill-health on income and leisure in health state valuations. Health Econ. 14, 643–647 (2005)

    Article  Google Scholar 

  20. Weinstein, M.C., Siegel, J.E., et al.: Productivity costs, time costs and health related quality of life: a response to the Erasmus group. Health Econ. 6, 505–510 (1997)

    Article  Google Scholar 

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Acknowledgements

Stuart Peacock is a scholar of the Michael Smith Foundation for Health Research. The views expressed in this paper are solely those of the authors.

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Authors and Affiliations

  1. Centre for Health Economics, Monash University, Building 75, Melbourne, VIC, 3800, Australia

    Jeff Richardson, Stuart J. Peacock & Angelo Iezzi

  2. Centre for Health Economics in Cancer, British Columbia Cancer Agency, Vancouver, Canada

    Stuart J. Peacock

  3. Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada

    Stuart J. Peacock

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  1. Jeff Richardson
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Correspondence to Jeff Richardson.

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Richardson, J., Peacock, S.J. & Iezzi, A. Do quality-adjusted life years take account of lost income? Evidence from an Australian survey. Eur J Health Econ 10, 103–109 (2009). https://doi.org/10.1007/s10198-008-0107-4

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