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

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Donaldson, Cam, Baker, Rachel, Mason, Helen, Jones-Lee, M. W., Lancsar, Emily, Wildman, John, Research fellow, Bateman, Ian, Loomes, Graham, Robinson, Angela, Sugden, R. C. (Robert Charles), Prades, Jose Luis Pinto, Ryan, Mandy, Shackley, Phil and Smith, Richard. (2011) The social value of a QALY : raising the bar or barring the raise? BMC Health Services Research, Vol.11 . article no.8. ISSN 1472-6963

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Official URL: http://dx.doi.org/10.1186/1472-6963-11-8

Abstract

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

Item Type:

Journal Article

Subjects:

R Medicine > RA Public aspects of medicine

Divisions:

Faculty of Social Sciences > Warwick Business School > Behavioural Science
Faculty of Social Sciences > Economics
Faculty of Social Sciences > Warwick Business School

Library of Congress Subject Headings (LCSH):

Medical policy -- Great Britain, National Institute for Health and Clinical Excellence (Great Britain) , Health expectancy -- Great Britain

Journal or Publication Title:

BMC Health Services Research

Publisher:

BioMed Central Ltd.

ISSN:

1472-6963

Official Date:

11 January 2011

Dates:

Date	Event
11 January 2011	Published

Volume:

Vol.11

Page Range:

article no.8

Identification Number:

10.1186/1472-6963-11-8

Status:

Peer Reviewed

Publication Status:

Published

Access rights to Published version:

Open Access

Funder:

Economic and Social Research Council (Great Britain) (ESRC), National Coordinating Centre for Research Methodology, National Institute for Health Research (Great Britain) (NIHR)

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