Talk:Quality-adjusted life year
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What does this have to do with philosophy? I could draw a connection if forced, but...--Chinawhitecotton 07:50, 21 February 2006 (UTC)
This article deals with a concept in economics, not medicine or philosophy. Healthcare planners use these to estimate resource allocation. It is rarely used in resolving ethical dilemmas in health care, except on the large-scale planning (economic) level.~~ —The preceding unsigned comment was added by 188.8.131.52 (talk) 14:02, 4 May 2007 (UTC).
"The meaning and usefulness of QALY is debated." I think we should put an emphasis on QALY, that it is a VERY simple "tool/model" for measuring quality (in life, of health etc). A simple tool can never become extremely complex/sophisticated, it just stays simple and helps trying to compare information - in this case QALY data of different i.e. humans. :) —Preceding unsigned comment added by 184.108.40.206 (talk) 03:14, 27 September 2007 (UTC) The Paper (QALYs) cited contains a huge misunderstanding from the standpoint of utility measurement theory. This article should not be cited without additional remarks. It might confuse the uninformed reader. The problem mentioned is that utility measured on interval scales can not be multiplied with any value, because the outcome is not invarirant w.r.t. positive affine transformations of the form Y'=aY+b, with Y and Y' being arbitrary utility scales and a>0. (Whether the second factor is measured on ratio or on interval scale doesn't matter, the statement "In order to be able to obtain coherent results, both scales would have to be expressed in the same units of measurements" in the abstract is simply wrong.) One can only use utility differences; and that is what they actually did in their so-called comple number model (figure 6). But you do not need the complex number model, one can simply multiply utility models with time. —Preceding unsigned comment added by Dschoch (talk • contribs) 07:01, 23 July 2008 (UTC)
Rosser & Kind Matrix
I believe QALYs were originally derived from a table which summarised the valuations a group of healthy people gave to various combinations of pain and mobility. Some such states were regarded as "worse than death" and so gained negative values. This reflects the common remark, "I'd rather be dead than in a wheelchair!" which results in the lives of disabled people being valued less by healthcare economists than those of the mobile and pain-free. I think hospital patients and professionals working with disabled people turned out to have similar values. The original work was led by Rachel Rosser, a professor of psychiatry in London, in the 1980s. I can't lay hands on the reference just now. NRPanikker 07:48, 2 October 2007 (UTC)
In response to the above, stating '...which results in the lives of disabled people being valued less by healthcare [sic] economists than those of the mobile and pain-free' is somewhat missing the point I think. A person in full health has no capacity to benefit from health care, whilst someone not in full health does. The focus of economic evaluation (at least on the outcomes side of the equation) is the gain in health from an intervention (or rather, the extra gain from one intervention compared with another). The QALY is simply a means of measuring overall health gain in a generic way, allowing comparison between many diverse interventions.EdW UK (talk) 19:41, 3 February 2009 (UTC)
Why should the opinions of the patient be considered irrelevant? If I'm in a wheelchair and I say I would rather be dead, it should be quite clear that at the very least I would not want massive intervention in case of, say, terminal cancer or a stroke. My wishes should be the final answer, regardless of the religious beliefs and financial incentives of the doctors, relatives, and institutions involved. If I were lucky enough to live where assisted suicide was a legal option, that should also be made available if I demand it. Given a person in a wheelchair who cannot communicate, the average opinions of those who can communicate are the best available basis for decision-making. The article now is disparaging of QALY, which is not justified. Fairandbalanced (talk) 01:53, 24 November 2009 (UTC)
Added discussion on the implicit underlying interpersonal utility assumptions in QALYs
I've added the following comment :
QALYs may also be inherently biased against older people who have fewer expected years of life. Many people may object to the implicit assumption that saving a younger person's life is worth many times that of saving an older person's life. At least, this implicit assumption should be made clear whenever QALYs are the basis for scarce resource allocation. QALYs therefore also violate the Pareto improvement principle which is at the core of all modern microeconomics, because QALYs inherently make interpersonal utility comparisons and therefore rely on "greater good" arguments rather than efficiency and mutual gain arguments for its theoretical underpinnings.
This comes from my understanding of QALYs from my past reading and reflection on this modeling approach. I do not have a reference for this material, since it comes from inference based on the model's definition. It is quite likely that someone out there (or perhaps many) have come up with similar critiques and published them. I would appreciate if you could add some references for this section if you have found some. I would also appreciate if you could email me at firstname.lastname@example.org with this info. Thank you. - G. Holt —Preceding unsigned comment added by 220.127.116.11 (talk) 05:06, 11 April 2009 (UTC)
Of course it is biased in favor of those who have more expected years of life. That is the the "Y" in QALY. If we are spending public money and have no medical directive for guidance, extending a 20-year old for 2 years should be given less value than extending a 65-year old for 3 years if no other factors are relevant. BTW, I think rich people should be allowed to waste money any harmless way they please, but medical directives should still be subject to finite financial limits based on QALY if using public money. Fairandbalanced (talk) 02:12, 24 November 2009 (UTC)
Before I embark on modifications, and I think the article is generally quite good, I draw attention to, and thus solicit input regarding, these issues: 1. The first (definition) sentence of this article is technically wrong. It's kind of close to right, but it needs correction, and should correspond to the two good refs that accompany it. This is not hard to do. 2. The article presently lacks international perspective, I think showing an overly UK-centric approach, and would benefit from, amongst others, German and US perspectives. This is not hard to do. 3. Both preventive care and care that avoids complications can be conceptualized as preventing loss of quality of health, so the present linguistic notion I perceive in the article that only actual "improvement" can be "captured" in QALY needs gentle expansion to allow for this (for the "prevention of loss"). This is not hard to do. 4. The QALY concept is the "standard" metric in the field, but as the article presently points out, the scoring systems for "what is Q" is often highly subjective, and has been shown to be dissimilar between different diseases or conditions, and between different "tester populations," impacting cost considerations by factors of as much as 10-fold (obviously very significant!) I agree with the tag that indicates that refs to high quality, secondary sources that are easily accessible and understandable is needed. A brief encyclopedic approach to this would not be too hard on my QALY either. So, if someone wants to get on with these edits that's great, or if there is some initial input that other editors want to make, I am holding off any edits for, say, 2-3 weeks, but I am then going to get into it.FeatherPluma (talk) 22:42, 5 April 2011 (UTC) Second notice of intent to modify as stated.FeatherPluma (talk) 08:57, 18 April 2011 (UTC)