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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, Professor of economics, 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
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)
References:	1. Phelps CE, Mushlin AI: On the (near) equivalence of cost-effectiveness and cost-benefit analyses. International Journal of Technology Assessment in Health Care 1991, 7:12-21. 2. Hirth RA, Chernew ME, Miller E, Fendrick M, Weissert WG: Willingness to pay for a quality-adjusted life year: in search of a standard. Medical Decision Making 2000, 20:332-42. 3. Gyrd-Hansen D: Willingness to pay for a QALY. Health Economics 2003, 12:1049-60. 4. Byrne MM, O’Malley K, Suarez-Almazor ME: Willingness to pay per quality adjusted life year in a study of knee osteoarthritis. Medical Decision Making 2005, 25:655-666. 5. King JT, Tsevat J, Lave J, Roberts MS: Willingness to pay for a quality adjusted life year: implications for societal resource allocation. Medical Decision Making 2005, 25:667-677. 6. Rawlins M, Culyer A: National Institute for Clinical Excellence and its value judgements. BMJ 2004, 329:224-7. 7. Devlin N, Parkin D: Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? Health Economics 2004, 13:437-452. 8. Clement FM, Harris A, Li JJ, Yong K, Lee KM, Manns BJ: Using effectiveness and cost-effectiveness to make drug coverage decisions. Journal of the American Medical Association 2009, 302:1437-1443. 9. House of Commons Health Committee: National Institute for Clinical Excellence. Second Report of Session 2001-02. The Stationary Office; 2002. 10. Lakhani N: The Price of life: it was £20,000. Now an NHS agency recalculates. Independent on Sunday 2008, 18-19. 11. Richards M: Improving access to medicines for NHS patients. Department of Health, London; 2008. 12. West D: Spending pressures spark call for NICE restraints. Health Service Journal; 2009. 13. Towse A: Should NICE’s threshold range for the QALY be raised? Yes. BMJ 2009, 338:268-269. 14. Raftery J: Should NICE’s threshold range for the QALY be raised? No. BMJ 2009, 338:268-269. 15. Mason H, Jones-Lee MW, Donaldson C: Modelling the monetary value of a QALY: a new approach based on UK data. Health Economics 2009, 18:933-950. 16. Baker R, Bateman I, Donaldson C, Jones-Lee M, Lancsar E, Loomes G, et 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 2010, 14(27). 17. Smith R, Porter A: NHS ordered to place more value on life. Daily Telegraph 2008, 1. 18. Martin S, Rice N, Smith PJ: Does health care spending improve health outcomes? Evidence from English programme budgeting data. Journal of Health Economics 2008, 27:826-842. 19. Appleby J, Devlin N, Parkin D, Chalkidou K, Buxton M: Searching for cost effectiveness thresholds in the NHS. Health Policy 2009, 9:239-245. 20. Department for Transport: Highways Economic Note No 1, 2005. London; 2007. 21. Jones-Lee MW, Loomes G, Philips P: Valuing the prevention of non-fatal road injuries: contingent valuation vs standard gambles. Oxford Economic Papers 1995, 47:676-695. 22. Donaldson C, Mason H, Shackley P: Contingent valuation in health care. Edited by: Jones A. The Elgar Companion to Health Economics. Elgar, Cheltenham; 2006. 23. Murray CJL, Lopez AD: The Global Burden of Disease: a Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. Harvard University Press, Cambridge; 1996. 24. Nord E: The trade-off between severity of illness and treatment effect in cost-value analysis of health care. Health Policy 1993, 24:227-238. 25. Nord E: The relevance of health state after treatment in prioritizing between different patients. Journal of Medical Ethics 1993, 19:37-42. 26. Brouwer W, van Exel J, Baker R, Donaldson C: The new myth: The social value of the QALY. PharmacoEconomics 2008, 26(1):1-4. 27. Mason H: Monetary valuation of health outcomes for use in national policy formulation. PhD thesis, Newcastle University; 2007. 28. Jones-Lee M, Loomes G, Spackman M: Human Costs of a Nuclear Accident: Final Report. Health and Safety Executive NERA Economic Consulting; 2007. 29. Mendeloff JM, Kaplan RM: Are large differences in ‘lifesaving’ costs justified ? A psychometric study of the relative value placed on preventing deaths. Risk Analysis 1989, 9:349-363. 30. Dolan P, Green C: Using the person trade-off approach to examine differences between individual and social values. Health Economics 1996, 7:307-312. 31. Nord E, Street A, Richardson J, Kuhse H, Singer P: The significance of age and duration of effect in social evaluation of health care. Health Care Analysis 1996, 4:103-111. 32. Johansson-Stenman O, Martinsson P: Are some lives more valuable? An ethical preferences approach. Journal of Health Economics 2008, 27:739-752. 33. Nord E, Richardson J, et al: Maximising health benefits versus egalitarianism: An Australian survey of health issues. Social Science & Medicine 1995, 41:1429-1437. 34. Nord E: Cost-value Analysis in Health Care. Cambridge University Press, Cambridge; 1999. 35. Abellan-Perpinan JM, Pinto-Prades JL: Health state after treatment: a reason for discrimination. Health Economics 1999, 8:701-708. 36. Ubel P, Richardson J, Pinto Prades JL: Life saving treatments and disabilities: Are all QALYs created equal? Int J of Techn Assessement in Health Care 1999, 15:738-748. 37. Dolan P, Cookson R: Measuring preferences over the distribution of health benefits. Mimeo. Centre for Health Economics, University of York; 1998. 38. Caro J: Methods for assessment of the relation of benefits to costs in the German Statutory Health Care System. IQWIG; 2008 [http://www.iqwig.de]. 39. National Institute for Health and Clinical Excellence: Social Value Judgements: Principles for the Development of NICE Guidance. NICE, London;, 2 2008.
URI:	http://wrap.warwick.ac.uk/id/eprint/4138