Chapter 10: Cost–utility analysis and equity
The QALYs that have been constructed so far have been built on the assumption that everyone’s QALYs are valued the same. In this chapter we analyze why and how to value individual or group QALYs differently. A major way that unequally weighted QALYs were introduced into CUA was via outcomes measured in terms of Disability Adjusted Life Years, DALYs. We cover DALYs in section 10.2 after we have clarified the meaning of equity and the role of QALY weights. DALYs give different weights to different age groups. Section 10.3 discusses the general issue of QALYs and age discrimination (ageism). Disability adjusted life years rely on a different instrument for measuring utilities, that is, the person trade-off (PTO) method. The case for and against the PTO method in CUA is presented in section 10.4. The final theme in the principles part of this chapter integrates the capability approach into economic evaluations of health care interventions. The applications cover studies based on DALYs and the capability approach.
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