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The social value of a QALY : raising the bar or barring the raise?

By Cam Donaldson, Rachel Baker, Helen Mason, M. W. Jones-Lee, Emily Lancsar, John Wildman, Ian Bateman, Graham Loomes, Angela Robinson, R. C. Sugden, Jose Luis Pinto Prades, Mandy Ryan, Phil Shackley and Richard Smith


Background: Since the inception of the National Institute for Health and Clinical Excellence (NICE) in England,\ud there have been questions about the empirical basis for the cost-per-QALY threshold used by NICE and whether\ud QALYs gained by different beneficiaries of health care should be weighted equally. The Social Value of a QALY\ud (SVQ) project, reported in this paper, was commissioned to address these two questions. The results of SVQ were\ud released during a time of considerable debate about the NICE threshold, and authors with differing perspectives\ud have drawn on the SVQ results to support their cases. As these discussions continue, and given the selective use of\ud results by those involved, it is important, therefore, not only to present a summary overview of SVQ, but also for\ud those who conducted the research to contribute to the debate as to its implications for NICE.\ud Discussion: The issue of the threshold was addressed in two ways: first, by combining, via a set of models, the\ud current UK Value of a Prevented Fatality (used in transport policy) with data on fatality age, life expectancy and\ud age-related quality of life; and, second, via a survey designed to test the feasibility of combining respondents’\ud answers to willingness to pay and health state utility questions to arrive at values of a QALY. Modelling resulted in\ud values of £10,000-£70,000 per QALY. Via survey research, most methods of aggregating the data resulted in values\ud of a QALY of £18,000-£40,000, although others resulted in implausibly high values. An additional survey, addressing\ud the issue of weighting QALYs, used two methods, one indicating that QALYs should not be weighted and the\ud other that greater weight could be given to QALYs gained by some groups.\ud Summary: Although we conducted only a feasibility study and a modelling exercise, neither present compelling\ud evidence for moving the NICE threshold up or down. Some preliminary evidence would indicate it could be\ud moved up for some types of QALY and down for others. While many members of the public appear to be open to\ud the possibility of using somewhat different QALY weights for different groups of beneficiaries, we do not yet have\ud any secure evidence base for introducing such a system

Topics: RA
Publisher: BioMed Central Ltd.
Year: 2011
OAI identifier: oai:wrap.warwick.ac.uk:4138

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  1. (2008). A: NHS ordered to place more value on life. Daily Telegraph
  2. (1995). al: Maximising health benefits versus egalitarianism: An Australian survey of health issues. doi
  3. (2010). al: Weighting and valuing quality-adjusted life-years using stated preference methods: preliminary results from the Social Value of a QALY project. Health Technol Assess doi
  4. (1989). Are large differences in ‘lifesaving’ costs justified ? A psychometric study of the relative value placed on preventing deaths. Risk Analysis doi
  5. (2008). C: The new myth: The social value of the QALY. PharmacoEconomics doi
  6. (2006). Contingent valuation in health care. Edited by: Jones A. The Elgar Companion to Health Economics. doi
  7. (1999). Cost-value Analysis in Health Care. doi
  8. (2004). Culyer A: National Institute for Clinical Excellence and its value judgements. BMJ doi
  9. (2004). Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? Health Economics doi
  10. (2008). for Health and Clinical Excellence: Social Value Judgements: Principles for the Development of
  11. (2002). House of Commons Health Committee: National Institute for Clinical Excellence. Second Report of Session 2001-02. The Stationary Office;
  12. (2007). Human Costs of a Nuclear Accident: Final Report. Health and Safety Executive NERA Economic Consulting;
  13. (2008). Improving access to medicines for NHS patients. Department of Health,
  14. Measuring preferences over the distribution of health benefits.
  15. (2008). Methods for assessment of the relation of benefits to costs in the German Statutory Health Care System. IQWIG;
  16. (2009). Modelling the monetary value of a QALY: a new approach based on UK data. Health Economics doi
  17. (2007). Monetary valuation of health outcomes for use in national policy formulation.
  18. (2005). MS: Willingness to pay for a quality adjusted life year: implications for societal resource allocation. Medical Decision Making doi
  19. (1991). On the (near) equivalence of cost-effectiveness and cost-benefit analyses. doi
  20. (1999). Pinto Prades JL: Life saving treatments and disabilities: Are all QALYs created equal?
  21. (1999). Pinto-Prades JL: Health state after treatment: a reason for discrimination. Health Economics doi
  22. (2008). PJ: Does health care spending improve health outcomes? Evidence from English programme budgeting data. doi
  23. (2009). Searching for cost effectiveness thresholds in the NHS. Health Policy doi
  24. (2009). Should NICE’s threshold range for the QALY be raised? doi
  25. (2009). Should NICE’s threshold range for the QALY be raised? Yes. BMJ doi
  26. (2009). Spending pressures spark call for NICE restraints. Health Service Journal;
  27. (2005). Suarez-Almazor ME: Willingness to pay per quality adjusted life year in a study of knee osteoarthritis. Medical Decision Making doi
  28. The Global Burden of Disease: a Comprehensive Assessment of Mortality and
  29. (2008). The Price of life: it was £20,000. Now an NHS agency recalculates. Independent on Sunday
  30. (1993). The relevance of health state after treatment in prioritizing between different patients. doi
  31. (1996). The significance of age and duration of effect in social evaluation of health care. Health Care Analysis doi
  32. (1993). The trade-off between severity of illness and treatment effect in cost-value analysis of health care. Health Policy doi
  33. (2009). Using effectiveness and cost-effectiveness to make drug coverage decisions. doi
  34. (1996). Using the person trade-off approach to examine differences between individual and social values. Health Economics doi
  35. (1995). Valuing the prevention of non-fatal road injuries: contingent valuation vs standard gambles. Oxford Economic Papers
  36. (2000). WG: Willingness to pay for a quality-adjusted life year: in search of a standard. Medical Decision Making doi
  37. (2003). Willingness to pay for a QALY. Health Economics doi

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