Health State Evaluation and Utility Theory
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.
KeywordsDisability Adjusted Life Years (DALY) Quality Adjusted Life Year (QALY) Social policy Utility theory Years of Healthy Life (HYL)
- 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
- 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
- Keeney, R.L., and H. Raiffa. 1976. Decisions with multiple objectives: Preferences and value tradeoffs. New York: Wiley.Google Scholar
- 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
- Von Neumann, J., and O. Morgenstern. 1944. The theory of games and economic behaviour. Princeton: Princeton University Press.Google Scholar