The New Palgrave Dictionary of Economics

2018 Edition
| Editors: Macmillan Publishers Ltd

Health State Evaluation and Utility Theory

  • Alastair McGuire
Reference work entry
DOI: https://doi.org/10.1057/978-1-349-95189-5_2863

Abstract

Valuing health outcomes is a fundamental concern in health economics. This article considers a measure of health outcomes: the Quality Adjusted Life Year (QALY). The QALY has been used extensively for two main reasons: (1) it arguably values health outcomes in a more acceptable metric than money does; and (2) it feeds more easily into the wider medical decision-making. To be an acceptable measure of health state preferences, however, the QALY requires a number of restrictive assumptions to hold. We discuss these assumptions and conclude that, if these do not hold, the QALY reverts to a measure of health state rather than to a health state preference.

Keywords

Disability Adjusted Life Years (DALY) Quality Adjusted Life Year (QALY) Social policy Utility theory Years of Healthy Life (HYL) 
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Bibliography

  1. Airoldi, M. 2007. Gains in QALYs vs. DALYs averted. The troubling implications of using residual life expectancy. LSE Health working paper no. 8. LSE, London.Google Scholar
  2. Airoldi, M., and A. Morton. 2009. Adjusting life for quality or disability: Stylistic difference or substantial dispute? Health Economics 18(11): 1237–1247.CrossRefGoogle Scholar
  3. Berthelot, J., R. Roberge, and M.C. Wolfson. 1993. The calculation of health adjusted life expectancy for a Canadian province using a multiattribute utility function: A first attempt. In Calculation of health expectancies: Harmonization, consensus achieved and future perspectives, ed. J.M. Robine, C.D. Mather, M. Bone, and I. Romieu, 161–172. Montpellier: Eurotext.Google Scholar
  4. Bleichrodt, H., and J.L. Pinto. 2005. The validity of QALYs under non-expected utility. The Economic Journal 115: 533–550.CrossRefGoogle Scholar
  5. Bleichrodt, H., and J. Quiggin. 1997. Characterizing QALYs under a general rank-dependent utility model. Journal of Risk and Uncertainty 15: 151–165.CrossRefGoogle Scholar
  6. Broome, J. 1993. QALYs. Journal of Public Economics 50: 149–167.CrossRefGoogle Scholar
  7. Dolan, P., and D. Kahneman. 2008. Interpretations of utility and their implications for the valuation of health. Economic Journal 118(525): 215–234.CrossRefGoogle Scholar
  8. Dolan, P., and P. Stalmeier. 2003. The validity of time trade-off values in calculating QALYs: Constant proportional time trade-off versus the proportional heuristic. Journal of Health Economics 22(3): 445–458.CrossRefGoogle Scholar
  9. Dolan, P., and A. Tsuchiya. 2010. Determining the parameters in social welfare function using stated preference data: An application to health. Applied Economics 43(18): 2241–2250.CrossRefGoogle Scholar
  10. Erickson, P., R.W. Wilson, and L. Shannon. 1995. Years of healthy life: Statistical note number 7. Hyattsville: National Center for Health Statistics.CrossRefGoogle Scholar
  11. Keeney, R.L., and H. Raiffa. 1976. Decisions with multiple objectives: Preferences and value tradeoffs. New York: Wiley.Google Scholar
  12. Little, I.M.D. 2002. Ethics, economics and politics. Oxford: Oxford University Press.CrossRefGoogle Scholar
  13. Mehrez, A., and A. Gafni. 1993. Healthy-years equivalents versus quality-adjusted life years: In pursuit of progress. Medical Decision Making 13(4): 287–292.CrossRefGoogle Scholar
  14. Miyamoto, J.M., P.P. Wakker, H. Bleichrodt, and H.J.M. Peters. 1998. A zero-condition: A simplifying assumption in QALY measurement and multiattribute utility. Management Science 44: 839–849.CrossRefGoogle Scholar
  15. Nord, E. 1992. Methods for quality adjustment of life years. Social Science & Medicine 34: 559–569.CrossRefGoogle Scholar
  16. Nord, E. 1994. The QALY – a measure of social value rather than individual utility? Health Economics 3(2): 89–93.CrossRefGoogle Scholar
  17. Oliver, A. 2005. Testing the internal consistency of the lottery equivalents method using health outcomes. Health Economics 14(2): 149–159.CrossRefGoogle Scholar
  18. Patrick, D.L., J.W. Bush, and M.M. Chen. 1973. Methods for measuring levels for well-being for a health status index. Health Services Research 8: 228–245.Google Scholar
  19. Pauker, S.G. 1976. Coronary artery surgery: The use of decision analysis. Annals of Internal Medicine 85: 8–18.CrossRefGoogle Scholar
  20. Pliskin, J.S., D.S. Shepard, and M.C. Weinstein. 1980. Utility functions for life years and health status. Operations Research 28: 206–224.CrossRefGoogle Scholar
  21. Sassi, F. 2006. Calculating QALYs, comparing QALY and DALY calculations. Health Policy and Planning 21: 402–408.CrossRefGoogle Scholar
  22. Spencer, A. 2003. A test of the QALY model when health varies over time. Social Science and Medicine 57: 1697–1706.CrossRefGoogle Scholar
  23. Von Neumann, J., and O. Morgenstern. 1944. The theory of games and economic behaviour. Princeton: Princeton University Press.Google Scholar
  24. Weinstein, M.C., and W.B. Stason. 1977. Foundations of cost-effectiveness analysis for health and medical practices. New England Journal of Medicine 296: 716–721.CrossRefGoogle Scholar
  25. Zeckhauser, R., and D.S. Shepard. 1976. Where now for saving lives? Law and Contemporary Problems 40: 5–45.CrossRefGoogle Scholar

Copyright information

© Macmillan Publishers Ltd. 2018

Authors and Affiliations

  • Alastair McGuire
    • 1
  1. 1.