Abstract
An important consideration when establishing priorities in healthcare is the likely effect that alternative allocations will have on the health-related quality of life (HR-QOL) of the relevant population. This paper considers some of the important issues and controversies surrounding the valuation of HR-QOL. It considers the theoretical and empirical evidence regarding 3 crucial questions: (i) what is to be valued?; (ii) how is it to be valued?; and (iii) who is to value it? Many important yet unresolved issues emerge and directions for future research are suggested. It is argued that this research agenda should have the gathering and analysis of qualitative data at its forefront.
Similar content being viewed by others
References
Jachuk SJ, Brierley H, Jachuk S, et al. The effect of hypertensive drugs on the quality of life. J R Coll Gen Pract 1982; 32 (235): 103–5
Ng YK. Welfare economics. London: MacMillan, 1992
Johannesson M, Jonsson B, Karlson G. Outcome measurement in economic evaluation. Health Econ 1996; 5: 279–96
Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. Oxford: Oxford University Press, 1989
Gold M, Siegal JE, Russell LB, et al. Cost-effectiveness in health and medicine. Oxford (NY): Oxford University Press, 1996
Mehrez A, Gafni A. Quality-adjusted life years: utility theory, and health-years equivalents. Med Decis Making 1989; 9: 142–9
Pliskin JS, Shepard DS, Weinstein MC. Utility functions for life years and health status. Oper Res 1980; 28: 206–44
Miyamoto JM, Eraker SA. Parameter estimates for a QALY utility model. Med Decis Making 1985; 5: 191–213
Bleichrodt H, Wakker P, Johannesson M. Characterizing QALYs by risk neutrality. J Risk Uncertainty 1997; 15: 107–114
Lipscomb J. Value preferences for health: meaning measurement and use in program evaluation. In: Kane RL, Kane RA, editors. Values and long term care. Lexington (MA): Lexington Books, 1982
Donaldson C. Willingness to pay for publicly-provided goods: a possible measure of benefit. J Health Econ 1990; 9: 103–18
Ryan M, Hughes J. Using conjoint analysis to assess women’s preferences for miscarriage management. Health Econ 1997; 6: 261–73
Torrance GW. Measurement of health state utilities for economic appraisal. J Health Econ 1986; 5: 1–30
von Neumann J, Morgenstern O. Theory of games and economic behaviour. New York: Wiley, 1953
Torrance GW, Feeny D. Utilities and quality-adjusted life years. Int J Technol Assess Health Care 1989; 5: 559–75
Llewellyn-Thomas H, Sutherland HJ, Tibshirani R, et al. The measurement of patients’ values in medicine. Med Decis Making 1982; 2: 449–62
Schoemaker PJH. The expected utility model: its variants, purposes, evidence and limitations. J Econ Lit 1982; 20: 529–63
Gafni A, Birch. Preferences for outcomes in economic evaluation: an economic approach to addressing economic problems. Soc Sci Med 1995; 40: 767–76
Richardson J. Cost-utility analysis: what should be measured? Soc Sci Med 1994; 39 (1): 7–21
Mehrez A, Gafni A. The health-years equivalents: how to measure them using the standard gamble approach. Med Decis Making 1991; 11: 140–6
Buckingham K, Drummond M. A theoretical and empirical classification of health valuation techniques. Health Economists Study Group (HESG) Conference; 1993 Jul 3-5; Strathclyde
Dolan P, Jones-Lee M. The time trade-off: a note on the effect of lifetime reallocation of consumption and discounting. J Health Econ 1997; 16: 731–9
Meyerowitz BE. Postmastectomy coping strategies and quality of life. Health Psychol 1983; 2: 117–32
Cassileth BR, Lusk EJ, Strouse TB, et al. Psychosocial status in chronic illness: a comparative analysis of six diagnostic groups. N Engl J Med 1984; 311: 506–11
Edgar A, Salek S, Shickle D, et al. The ethical QALY: ethical issues in healthcare resource allocations. Haslemere: Euromed Communications, 1998
Richardson J, Hall J, Salkfeld G. The measurement of utility in multiphase health states. Int J Technol Assess Health Care 1996; 12: 151–62
Kupperman M, Shiboski S, Feeny D, et al. Can preference scores for discrete states be used to derive preference scores for an entire path of events? Med Decis Making 1997; 17: 42–55
Froberg DG, Kane RL. Methodology for measuring health state preferences II: scaling methods. J Clin Epidemiol 1989; 42: 459–71
Dolan P, Gudex C, Kind P, et al. Valuing health states: a comparison of methods. J Health Econ 1996; 15: 209–31
Torrance GW. Social preferences for health states: an empirical evaluation of three measurement techniques. Socioecon Plann Sci 1976; 10: 129–36
Reed WW, Herbers JE, Noel GL. Cholesterol lowering therapy: what patients expect in return. J Gen Intern Med 1993; 8: 591–6
Bleichrodt H, Johannesson M. Standard gamble, time trade-off and rating scale: experimental results on the ranking properties of QALYs. J Health Econ 1997; 16: 155–75
Wolfson AD, Sinclair AJ, Bombardier C, et al. Preference measurements for functional status in stroke patients: interrater and intertechnique comparisons. In: Kane RL, Kane RA, editors. Values and long term care. Lexington (MA): Lexicon Books, 1982
Read JL, Quinn RJ, Berrick DM, et al. Preferences for health outcomes: comparison of assessment methods. Med Decis Making 1984; 4 (3): 315–29
Stiggelbout AM, Kiebert GM, Kievit J, et al. Utility assessment in cancer patients: adjustment of time trade-off scores for the utility of life years and comparison with standard gamble scores. Med Decis Making 1994; 14: 82–90
Lenert LA, Cher DJ, Goldstein MK, et al. The effect of search procedures on utility elicitations. Med Decis Making 1998; 18: 76–83
Hornberger JC, Redelmeier DA, Petersen J. Variability among methods to assess patients well-being and consequent effect on a cost-effectiveness analysis. J Clin Epidemiol 1992; 45 (5): 505–12
Loomes G. Disparities between health state measures: is there a rational explanation? In: Gerrard W, editor. The economics of rationality. London: Routledge, 1993
van Busschbach J. The validity of QALYs [dissertation]. Rotterdam: Erasmus University, 1994
Stiggelbout AM, Eijkemans MJC, Kiebert GM, et al. The ‘utility’ of the visual analog scale in medical decsion making and technology assessment: is it an alternative to the time trade off? Int J Technol Assess Health Care 1996; 2: 291–8
Dolan P, Sutton M. Mapping visual analogue scale scores onto time trade-off and standard gamble utilities. Soc Sci Med 1997; 44: 1519–30
Bleichrodt H, Johannesson M. An experimental test of a theoretical foundation for rating scale valuations. Med Decis Mak 1997; 17: 208–16
Froberg DG, Kane RL. Methodology for measuring health state preferences III: population and context effects. J Clin Epidemiol 1989; 42: 585–92
Sackett DL, Torrance GW. The utility of different health states as perceived by the general public. J Chronic Dis 1978; 31: 697–704
Dolan P, Gudex C, Kind P, et al. The time trade-off method: results from a general population study. Health Econ 1996; 5: 141–54
Dolan P. The effect of experience of illness on health state valuations. J Clin Epidemiol 1996; 49: 551–64
Llewellyn-Thomas H, Sutherland HJ, Tibshirani R, et al. Descibing health states: methodologic issues in obtaining values for health states. Med Care 1984; 22: 543–52
Daly E, Gray A, Barlow D, et al. Measuring the impact of menopausal symptoms on quality of life. BMJ 1993; 307: 836–40
Fitzpatrick R. A pragmatic defence of health status measures. Health Care Anal 1996; 4: 265–72
Lockwood M. Quality of life and resource allocation. In: Bell M, Mendus S, editors. Philosophy and medical welfare. Cambridge: Cambridge University Press, 1988
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dolan, P. Valuing Health-Related Quality of Life. Pharmacoeconomics 15, 119–127 (1999). https://doi.org/10.2165/00019053-199915020-00001
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-199915020-00001