New publication on identifying the worse off across diseases
A new article published in Cost Effectiveness and Resource Allocation (CERA) by Global Health Priorities researchers Frode Lindemark, Ole Frithjof Norheim and Kjell Arne Johansson illustrates how information from published health economic evaluations can be used to measure lifetime QALYs, absolute and proportional shortfall of QALYs for eight different example diseases. Resource allocation decisions currently lack standard quantitative methods for incorporating concerns about the worse off when analysing the cost-effectiveness of medical interventions.
The authors argue that giving extra weight to interventions for those with the fewer lifetime QALYs, which yields similar results as absolute shortfall of QALYs, better captures underlying concerns for fair distribution of health. The use of lifetime QALYs and absolute shortfall of QALYs would seek to reduce inequalities in lifetime health, while the use of proportional shortfall of QALYs would seek to reduce inequalities in the future health potential only.
The paper is highly relevant to ongoing healthcare priority setting processes in the UK and Norway. NICE has proposed to give consideration to proportional and absolute shortfall of QALYs in the appraisal of health technologies, and may allow the cost-per-QALY to increase more than twice above the normal threshold range on the basis of these considerations. The third Norwegian National Committee on Priority Setting in Health Care is debating the same issue. The committee will present their white paper to the Ministry of Health and Care Services in November 2014.
Frode Lindemark, Ole Frithjof Norheim and Kjell Arne Johansson. Making use of equity sensitive QALYs: a case study on identifying the worse off across diseases. Cost Eff Resour Alloc. 2014. July 23;12:16 doi:10.1186/1478-7547-12-16