winner of the best scientific paper in health economics published in 2009 awarded by the Association of Health Economics in 2010.
The goal of rigorous and elaborate article by Pinto-Prades JL, Loomes G, Brey R in the Journal of Health Economics ( Monetary Trying to Estimate a value for the QALY . 2009; 28: 553-562) is to estimate the monetary value of years of quality-adjusted life-related health status (AVAC) and check the robustness of the conditions that would necessary to obtain a monetary value only from questions that involve different combinations of quality of life, duration and risk.
To achieve this goal using two questionnaires about willingness to pay applied to the general English population (n = 892). The first questionnaire was designed to analyze the stability of monetary value for variations in the severity of several diseases, the duration or permanence in each state of health and in reducing the risk of chronic diseases that pose a significant loss quality of life. This questionnaire presents eleven scenarios to respondents in the hypothetical case of developing a particular disease chronic, which differ in treatment, the cost, time until treatment takes effect, the duration of symptoms, severity of disease and the risk of the disease. The utilities of health states were obtained by the standard method called lottery. The willingness to pay is obtained by a process management card monthly payment for a certain period (eg 30 € for one year). The first questionnaire was applied to 7 groups of 80 persons (n \u200b\u200b= 560).
The second questionnaire was designed to clarify some results obtained in the first questionnaire and to assess health gains smaller. This questionnaire contains 6 stages and applied to 4 groups of 83 persons (n \u200b\u200b= 332). The format is multiple responses (5 choices) rather than binary (yes / no) as the first questionnaire.
The results of the first questionnaire showed that the monetary value of QALYs is quite sensitive to the order of the questions, the duration of the improvement in health status, method of obtaining the profit (direct versus chains) and the reduction risk. The results are, however, insensitive to the duration of payment. When you start giving the interviewee the smallest gain in health, the willingness to pay obtained is smaller. Volatility attributed to violations of procedure invariance (effect of order of questions, the effect of the payment period and effects of the procedure for obtaining profits) leads to monetary values \u200b\u200branging between 18,000 € and 112,000 €.
The second questionnaire shows that the estimated monetary values \u200b\u200bare systematically influenced by the choice of attributes and varying levels of each scenario and the magnitude of this variation.
The results indicate that it is doubtful that you can get a single monetary value of QALYs due to variations in the estimated monetary value of QALYs that violate the assumption that the provision to pay is proportional to QALYs and violate the invariance of the process to obtain monetary values. There
previous literature to the article by Pinto, Loomes and Brey, both theoretical and applied research, which highlights difficulties inherent in the procedures to obtain monetary values \u200b\u200bfor health gains as well as theoretical arguments against the existence of a value AVAC unique.
This article won the award for best paper in health economics awarded by the Association of Health Economics 2010, has the virtue of presenting rigorous empirical evidence on both the existence and magnitude of the variability of the monetary values \u200b\u200bassociated with attributes and levels of scenarios, as well as the lack of sensitivity of the estimated values \u200b\u200bfor levels of attributes for which should be sensitive (the duration of the payment, example). For the first time to quantify the variability (and insensitivity) of estimates of the monetary value of QALYs.
What are the implications of these findings for research in health economics and decision-making on technological innovations taking into account the social willingness to pay based on maximum monetary values \u200b\u200bof QALYs?
First, economic research must follow a path which we glimpse long enough, to allow separate variability derived from the method of estimating real variability of the willingness to pay of individuals for improvements in health status.
Secondly, it is essential to deepen the understanding of the mechanisms and magnitude of real variability, or whatever it may be obtained without violating the invariance of the procedure.
And thirdly, to move in a flexible yet objective and transparent application of limits on the maximum willingness to pay to the decision-making about adoption and degree of innovation funding health. Note that the estimated monetary value of QALYs is necessary to know whether the value of the health benefits of a technology or product is higher or lower social costs thereof. However, decisions of inclusion and degree of public coverage is not sufficient to know the value of the benefit exceeds the cost of innovation, this is a necessary condition for not exclude innovation, but not enough to ensure that public coverage 100% as this is also the opportunity cost of this decision and the budget constraint (which is the opportunity cost resulting from the treatments that displace the inclusion in public coverage as the budget currently available?).
