What is wrong with QALYs?

A paper by Rand and Kesselheim (2021) in Health Affairs this month conducts a systematic literature review to answer this question. Based on 113 articles they identified in peer-reviewed journals, they identify the following 10 criticisms categories. The graph above has each criticism category and the number of peer-reviewed articles that mention this critique type.…

Is the value of a QALY constant?

Standard cost-effectiveness analysis assumes that any gain in quality-adjusted life years (QALYs) should be valued equally. This does not sound unreasonable, but is it true in practice? Consider two potential violations of constant value of QALY gains: scope insensitivity and severity independence. I define each of these below: Scope insensitivity. This assumes that individuals value…

How much is your life worth?

How much should we value life? This is the question put forth in an interesting book by Howard Steven Friedman called Ultimate Price. The book reviews how economists, policymakers, philosophers and others place a monetary value on life. This could be a value courts place when making awards in lawsuits due to harm or death,…

Children and Cost-Benefit Analysis

Alan Balch, PhD, discusses the Institute for Clinical and Economic Review’s (ICER’s) Value Assessment Framework tool that aims to provide stakeholders in healthcare with evidence to make more informed decisions regarding new cancer therapies. Dr Balch also considers limitations to the tool’s effectiveness. Plus, he even discusses why if we lived life using a strict…

Quality of Life and Prospect Theory

Prospect theory states that individuals view transactions relative to a fixed reference point.  Individuals are risk averse for gains (i.e., they would prefer $10 for sure over a 50/50 of winning $0 or $20) but risk loving over losses (i.e., they would prefer a 50/50 ‘lottery’ of losing $0 or $20 over a sure loss of $10.…