Presentation on theme: "1 The Future of Quality of Life Assessment in Cost-Effectiveness Research Prof. Jan J. v. Busschbach, Ph.D. Erasmus MC Medical Psychology and Psychotherapy."— Presentation transcript:
1 The Future of Quality of Life Assessment in Cost-Effectiveness Research Prof. Jan J. v. Busschbach, Ph.D. Erasmus MC Medical Psychology and Psychotherapy Viersprong Institute for studies on Personality Disorders
QoL in HTA: QALY
In the past, much criticism Cohen CB. Quality of life and the analogy with the Nazis. Journal of Medicine and Philosophy 8: , 1983.
Criticism remains 4 ….the strictly fascist essence of those QALYs (so-called Quality-Adjusted Life Years)…
But QALY rules… From 1980 till 2010: 7049 publications in PubMed
There is not yet an alternative…
Raad voor de Volksgezondheid en Zorg Weight QALYs by severity of illness QALYs determine “severity” 7
Value based pricing Health Secretary Andrew Lansley Measures "will help ensure better access for patients to effective drugs and innovative treatments on the NHS" Like RvZ Again adding severity Adding Innovation QALY still at the hart of the judgment Severity and innovation both expressed terms of QALYs 8
Efficiency frontier Germany IQWiG Still discussion whether it is possible ‘in theory’ to make such value judgments, let alone in practice 9
Which measure? Questionnaires EQ-5D HUI SF-6D Direct measures TTO Discrete choice SG VAS
Questionnaires EQ-5D Dominates health economics Said to be insensitive New 5 level version is on its way SF-6D Overtook HUI in popularity Little support development HUI Little recent development Expensive
Disease specific instruments As validation methodology becomes cheaper… Why not validate a disease specific instrument? The big research question Are values valid? Are the values the same as with HUI, SF-6D etc Narrow scope Values are too high Attention bias Differences are too big
Bold-on instruments Combine generic instruments with disease specific dimensions “Bold-on” the disease specific dimension Can solve the narrow scope Absolute value level might be valid Could avoid attention bias Does it also avoid the attention bias?
Direct measures Used to value health states in models TTO dominates Discrete choicecoming up SGslips aside VASnot in favor in health economics WTPnever more than a promise
The big questions TTO Values below dead Discrete choice Is discrete choice valid within the QALY approach? How to anchor in death – normal health scale TTO?
Care QALY in care is disputed But QALY is ok for big issues in care No care = dead QALY might not be sensitive Care might be involve other aspects than health For instance: does not measure autonomy Same issues as in cure? Disease specific instrument Involve need and innovation
Discrete choice in care New instrument for care ICECAP ASCOTT Several other initiatives What is the relation with QALY? Why go for another scale? 17
Conclusion: Standardization Questionnaires Could merge to EQ-5D But disease specific instruments might blur Direct valuation TTO seems to prevail, but not yet one methodology Care Just the start of development 18
Future questionnaires CheapEQ-5DSF-6DHUI SensitiveSF-6DHUIEQ-5D (3L) Simple to useEQ-5DSF-6DHUI Many translationsSF-6DEQ-5DHUI Many value setsEQ-5DHUISF-6D Will EQ-5D-5L dominate? There must be room for more instruments…