Comparing the Noncomparable: The Need for Equivalence Measures That Make Sense in Health-Economic Evaluations.
Background: The popularity of quality-adjusted life years (QALYs) has been resistant to concerns about validity and reliability. Utility-theoretic outcome equivalents are widely used in other areas of applied economics. Equivalence values can be derived for time, money, risk, and other metrics. Thes...
| Publicado en: | Value in Health Vol. 22; no. 6; pp. 684 - 693 |
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| Autores principales: | , , , , |
| Formato: | research Journal Article |
| Publicado: |
Elsevier B.V.
Jun2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=136934953&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 136934953 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10983015 FSN jtl: Value in Health issn: 10983015 maglogo: N pubinfo: dt: Jun2019 vid: 22 iid: 6 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 136934953 136934953 NLM31198186 136934953 10.1016/j.jval.2019.03.011 NLM31198186 136934953 ppf: 684 ppct: 9 formats: tig: atl: Comparing the Noncomparable: The Need for Equivalence Measures That Make Sense in Health-Economic Evaluations. aug: au: Johnson, F. Reed Scott, Frank I. Reed, Shelby D. Lewis, James D. Bewtra, Meenakshi affil: Department of Population Health Sciences & Duke Clinical Research Institute, Duke University, Durham, NC, USA sug: subj: Quality-Adjusted Life Years Cost Benefit Analysis Standards Models, Statistical Cost Benefit Analysis Statistics and Numerical Data Reproducibility of Results Human Time Factors Cost Benefit Analysis Methods Validation Studies Comparative Studies Evaluation Research Multicenter Studies Ferrans and Powers Quality of Life Index Questionnaires Scales ab: Background: The popularity of quality-adjusted life years (QALYs) has been resistant to concerns about validity and reliability. Utility-theoretic outcome equivalents are widely used in other areas of applied economics. Equivalence values can be derived for time, money, risk, and other metrics. These equivalence measures preserve all available information about individual preferences and are valid measures of individual welfare changes.Objective: The objective of this study was to derive alternative generalized equivalence measures from first principles and illustrate their application in an empirical comparative-effectiveness example.Methods: We specify a general-equilibrium model incorporating neoclassical utility functions, health production function, severity-duration preferences, and labor-market tradeoff function. The empirical implementation takes advantage of discrete-choice experiment methods that are widely accepted in other areas of applied economics and increasingly in health economics. We illustrate the practical significance of restrictive QALY assumptions using comparative-effectiveness results based on both QALYs and estimates of welfare-theoretic time-equivalent values for anti-tumor necrosis factor and prolonged corticosteroid treatments for Crohn's disease in three distinct preference classes.Results: The QALY difference between the two treatments is 0.2 months, while time-equivalent values range between 0.5 and 1.3 months for aggregate and class-specific differences. Thus, the QALY-based analysis understates welfare-theoretic values by 60%-85%.Conclusion: These results suggest that using disease-specific equivalence values offer a meaningful alternative to QALYs to compare global outcomes across treatments. The equivalence values approach is consistent with principles of welfare economics and offers several features not represented in QALYs, including accounting for preference nonlinearities in disease severity and duration, inclusion of preference-relevant nonclinical healthcare factors, representing preferences of clinically-relevant patient subpopulations, and including utility losses related to risk aversion. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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