This article deeply examines the possible effects of the prohibition on using cost per QALY as the threshold and the discouragement on further research on cost-effectiveness analysis. I agree with the authors that when curbing health spending remains the focus for health reform, legislating restriction on the evaluation of interventions based on cost-effectiveness analysis to inform policy makers is disappointing.
I believe even those against the use of cost-per-QALY ratios to determine the efficiency of different interventions and hence to inform the decision making on resource allocation will not deny its advantages. Policy makers desire objective numbers and explicit graphs, by which they can easily make comparison and prediction. We can do little with the conflict of interests among stakeholders, but we can make the best efforts in reducing biases due to inaccurate information. QALYs equips us with such a tool that enables us to measure health benefits of different nature on a standard benchmark. It transfers all the health gains and loss into quality-weighted years of life for the population. Admittedly, perspectives on the meanings of quality are culturally contextual and may differ among populations, the emphasis on little painfulness and disability basically remains the same. Therefore, QALYs has been continuously introduced in the evaluation of effectiveness of interventions across diverse disease and conditions.
As many other methods correlated to cost and resource allocation, issues on equity and ethics arise when employing cost-per-QALYs to make policy recommendations. People are questioning the rationality of the distribution of the scarce resources. It will be unreasonable to deprive a person’s right to receive health care only because such kind of care by its virtue or the subject to whom such care will be offered will be of little effects on the improvement in extending his or her life of quality. But I guess the absolute equity in resource distribution will only come to reality when human are strong enough to embrace such super productivity that supply always outweigh demand in every aspects. It will be even more costly if we avoid and deny the fact that we are now and will continue to struggle in a world with scarce resources for a long time. This means that we will always have to determine priorities and selections. If there aren’t such reasonable and transparent tools to inform the process of decision making, there will be more unfairness and waste of resources.
Moreover, we can still improve the validity and accuracy of the using QALYs as a technology. Currently, according to the article, the most controversial point in employing QALYs as the dominant benchmark to inform decisions on resource allocation lie in the worries that it may technically impair the potential that the elderly and disabled to get benefit from the health policies. It is true that they may be relatively disadvantageous in obtaining more years of good life by the traditional definition of quality. However, I am wondering that whether we can update our concepts on the components contributing to the core of quality. We have already introduced the idea of weighing years of life on quality and absence of disability not just the number of years of life, why not weighing the quality of “quality” by adjusting values and emphasis among different population of different characteristics such as age and disease. For example, quality of life to a junior high may refers to chances of higher education and desirable family environment for development; however, for an end-of-life elderly, he or she may only wish to live peacefully and painlessly.
In a word, I will support continuous development in the research and employment on cost-effectiveness analysis. However, there will be certainly something we should and can do better in the future.
I agree with qiuqiu's view on this article which underlines the importance of QALYs in making health care decision. I concord with author's stand on importance of such measurement tools to keep check on the ever rising health care cost. They play a very important role in comparing two intervention to a specific pathology which might be same in all aspects but QALYs. Although there might be some limitation while comparing QALYs across different intervention for different pathology. The authors also emphasize that QALYs do take into account the disable and other disadvantaged people so that equity of health resource allocation is maintained. I personally do not see a significant benefit to the health care industry by preventing cost effectiveness research when these are among the very few tools available to content the skyrocketing health care costs.
This article deeply examines the possible effects of the prohibition on using cost per QALY as the threshold and the discouragement on further research on cost-effectiveness analysis. I agree with the authors that when curbing health spending remains the focus for health reform, legislating restriction on the evaluation of interventions based on cost-effectiveness analysis to inform policy makers is disappointing.
ReplyDeleteI believe even those against the use of cost-per-QALY ratios to determine the efficiency of different interventions and hence to inform the decision making on resource allocation will not deny its advantages. Policy makers desire objective numbers and explicit graphs, by which they can easily make comparison and prediction. We can do little with the conflict of interests among stakeholders, but we can make the best efforts in reducing biases due to inaccurate information. QALYs equips us with such a tool that enables us to measure health benefits of different nature on a standard benchmark. It transfers all the health gains and loss into quality-weighted years of life for the population. Admittedly, perspectives on the meanings of quality are culturally contextual and may differ among populations, the emphasis on little painfulness and disability basically remains the same. Therefore, QALYs has been continuously introduced in the evaluation of effectiveness of interventions across diverse disease and conditions.
As many other methods correlated to cost and resource allocation, issues on equity and ethics arise when employing cost-per-QALYs to make policy recommendations. People are questioning the rationality of the distribution of the scarce resources. It will be unreasonable to deprive a person’s right to receive health care only because such kind of care by its virtue or the subject to whom such care will be offered will be of little effects on the improvement in extending his or her life of quality. But I guess the absolute equity in resource distribution will only come to reality when human are strong enough to embrace such super productivity that supply always outweigh demand in every aspects. It will be even more costly if we avoid and deny the fact that we are now and will continue to struggle in a world with scarce resources for a long time. This means that we will always have to determine priorities and selections. If there aren’t such reasonable and transparent tools to inform the process of decision making, there will be more unfairness and waste of resources.
Moreover, we can still improve the validity and accuracy of the using QALYs as a technology. Currently, according to the article, the most controversial point in employing QALYs as the dominant benchmark to inform decisions on resource allocation lie in the worries that it may technically impair the potential that the elderly and disabled to get benefit from the health policies. It is true that they may be relatively disadvantageous in obtaining more years of good life by the traditional definition of quality. However, I am wondering that whether we can update our concepts on the components contributing to the core of quality. We have already introduced the idea of weighing years of life on quality and absence of disability not just the number of years of life, why not weighing the quality of “quality” by adjusting values and emphasis among different population of different characteristics such as age and disease. For example, quality of life to a junior high may refers to chances of higher education and desirable family environment for development; however, for an end-of-life elderly, he or she may only wish to live peacefully and painlessly.
In a word, I will support continuous development in the research and employment on cost-effectiveness analysis. However, there will be certainly something we should and can do better in the future.
I agree with qiuqiu's view on this article which underlines the importance of QALYs in making health care decision. I concord with author's stand on importance of such measurement tools to keep check on the ever rising health care cost. They play a very important role in comparing two intervention to a specific pathology which might be same in all aspects but QALYs. Although there might be some limitation while comparing QALYs across different intervention for different pathology. The authors also emphasize that QALYs do take into account the disable and other disadvantaged people so that equity of health resource allocation is maintained.
ReplyDeleteI personally do not see a significant benefit to the health care industry by preventing cost effectiveness research when these are among the very few tools available to content the skyrocketing health care costs.