Wednesday, March 25, 2009

Pricing Life

Princeton economics professor Uwe E. Reinhardt offers some interesting views in the New York Times' Economix blog about the use of Quality of Additional Life Years as a mechanism to gauge the cost-effectiveness of medical interventions.

"A medical intervention yielding a given number of additional life-years in perfect health makes a greater contribution to human well-being than an intervention that yields the same number of life-years in less-than-perfect health," Reinhardt writes. "QALYs are used to adjust for that difference in a patient’s quality of life."

That would appear to make a case for prevention measures aimed at keeping people healthier throughout the life span.

"Cheap interventions might be immunization for infectious diseases, which might save a large number of QALYs at relatively low cost," he wrote. "...Expensive interventions might involve new biological specialty drugs costing $100,000 or more per treatment that might add only a month or two to a terminally ill person’s life, or even low-cost diagnostic tests that do not detect much illness because they are applied to low-risk populations.

Ultimately, he says, reformers face two vexing questions: "Is there a maximum price per quality-adjusted life year (or life-month or life-day) beyond which society will not buy additional QALYs from the health system?" and "If there is a maximum price, should it be the same for all members of society – rich or poor, prominent or not...?"


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