Prevention Matters

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...?"