A study of the quality of life and cost-utility of renal transplantation

Cost-benefit analysis (CBA) provides a clear decision rule: undertake an intervention if the monetary value of its benefits exceed its costs. However, due to a reluctance to characterize health benefits in monetary terms, users of cost-utility and cost-effectiveness analyses must rely on arbitrary standards (e.g., < $50,000 per QALY) to deem a program "cost-effective." Moreover, there is no consensus regarding the appropriate dollar value per QALY gained upon which to base resource allocation decisions. To address this, the authors determined the value of a QALY as implied by the value-of-life literature and compared this value with arbitrary thresholds for cost-effectiveness that have come into common use. A literature search identified 42 estimates of the value of life that were appropriate for inclusion. These estimates were classified by method: human capital (HK), contingent valuation (CV), revealed preference/job risk (RP-JR) and revealed preference/non-occupational safety (RP-S), and by U.S. or non...

Willingness to Pay for a Quality-adjusted Life Year: In Search of a Standard

When costs and benefits are weighed together, technological advances have proved to be worth far more than their costs. by David M. Cutler and Mark McClellan ABSTRACT: Medical technology is valuable if the benefits of medical advances exceed the costs. We analyze technological change in five conditions to deter- mine if this is so. In four of the conditions—heart attacks, low-birthweight infants, depression, and cataracts—the estimated benefit of technological change is much greater than the cost. In the fifth condition, breast cancer, costs and benefits are about of equal magnitude. We conclude that medical spending as a whole is worth the increased cost of care. This has many implications for public policy. I t is widely accepted that technological change has ac- counted for the bulk of medical care cost increases over time. But it does not necessarily follow that technological change is there- fore bad. Presumably, technological change brings benefits in addi- tion to costs—increased longevity, improved quality of life, less time absent from work, and so on. These benefits need to be compared with the costs of technology before welfare statements can be made. Technological change is bad only if the cost increases are greater than the benefits. In aggregate, health has improved as medical spending has in- creased. Given then prevailing medical spending by age, the average newborn in 1950 could expect to spend $8,000 in present value on medical care over his or her lifetime. The comparable amount in 1990 is $45,000. An infant born in 1990 had a life expectancy that was seven years greater than that of the one born in 1950, and lower lifetime disability as well. 1 But how much of the health improvement is a result of medical care? Is the medical component worth it? These questions capture perhaps the most critical issue in the economic

https://scholar.harvard.edu/files/cutler/files/is_technological_change_in_medicine_worth_it.pdf

Is Technological Change In Medicine Worth It

The objective of this article was to describe and illustrate a comprehensive approach for estimating clinically important differences (CIDs) in health-related quality-of-life (HR-QOL). A literature review and pilot study were conducted to determine whether effect size-based benchmarks are consistent with CIDs obtained from other approaches.

Determining Clinically Important Differences in Health Status Measures

Over the past half century, Americans spent a rising share of total economic resources on health and enjoyed substantially longer lives as a result. Debate on health policy often focuses on limiting the growth of health spending. We investigate an issue central to this debate: Is the growth of health spending a rational response to changing economic conditions—notably the growth of income per person? We develop a model based on standard economic assumptions and argue that this is indeed the case. Standard preferences— of the kind used widely in economics to study consumption, asset pricing, and labor supply—imply that health spending is a superior good with an income elasticity well above one. As people get richer and consumption rises, the marginal utility of consumption falls rapidly. Spending on health to extend life allows individuals to purchase additional periods of utility. The marginal utility of life extension does not decline. As a result, the optimal composition of total spending shifts toward health, and the health share grows along with income. In projections based on the quantitative analysis of our model, the optimal health share of spending seems likely to exceed 30 percent by the middle of the century.

/pdf/the-value-of-life-and-the-rise-in-health-spending-4k9h243sad.pdf

The Value of Life and the Rise in Health Spending

The Beaver Dam Health Outcomes Study (BDHOS) is an ongoing longitudinal cohort study of health status and health-related quality of life for a random sample of adults (age range at interview was 45 to 89 years; mean = 64.1, SD = 10.8) in a community population. In a face-to-face interview lasting approximately an hour, each participant responds to several batteries of questions. Included are a history of chronic medical conditions, current medications, and past surgeries; the SF-36 (a general health-status questionnaire); the Quality of Well-being index; self-rated health status on a five-point scale from "excellent" to "poor"; and evaluation of current health using the method of time tradeoffs. The authors present results from 1,356 interviews on these four principal measures, reporting mean scores by sex, by age, and for persons reporting being affected by various medical conditions. They believe data from the BDHOS will provide researchers and policy makers a reference collection of vital statistics for health-related quality of life. Additionally, the data provide a way to compare results from studies that utilize different indices from among the four principal measures of the BDHOS.

Kathy Peterson

Papers

The Beaver Dam Health Outcomes study: Initial Catalog of Health-state Quality Factors