The rule is confirmed in a variety of studies, including one of patients with intermittent claudica- tion, a condition characterized by muscle pain (aches and cramping) and numb- ness or fatigue due to inadequate blood flow to the muscle. In severe cases, surgery is indicated. Second, and perhaps not surprisingly, physicians tend to assign higher utility scores than patients do to any given condition. It ap- pears that healthy people underestimate the pain and suffering of others. Third, as is shown in a study of depression out- lined in Table 3, the utility associated with temporary mild depression is about the same as that of kidney
dialysis; the utility associated with temporary moderate
depression is lower than being blind. These figures should
cause us to reflect on the severity of clinical depression, not
to mention its frequency in the general population. According
to author David M. Cutler in Your Money or Your Life, one in
five adults in the United States at any given time suffers from
some form of mental illness. Mental illness is second only to
hypertension in prevalence. Suicide is the third leading cause
of death for people aged 15 to 24 and the fifth leading cause for
people 25 to 44.
To put the QALY of depression in perspective, recall that
people who suffer from temporary depression:
Are willing to give up 150 days per year of their lives in ex- ■
change for a cure if the depression is mild;
Are willing to give up 248 days per year of their lives in ex- ■
change for a cure if the depression is moderate;
Are willing to give up 332 days per year of their lives in ex- ■
change for a cure if the depression is severe.
All these studies confirm the strengths of QALYs as metrics
of morbidity and mortality combined, as well as their effectiveness in helping to understand the health assessments made by
individuals with impairments (that is, how they appraise the
priceless). But QALYs can also be a powerful tool in decision-making analysis.
Resource Allocation
Imagine the following simplified situation: The state of Connecticut has created a $10,000,000 fund to pay for some of 11
initiatives that could increase the well-being of its residents.
Which ones should be chosen?
To answer this question, it’s necessary to establish
cost-benefit comparisons. Estimating costs is relatively
straightforward, but quantifying benefits is a more daunting
task. Fortunately, it’s one that’s more easily accomplished
with QALYs. Program A (e.g., new “miracle” drugs that control severe cases of diabetes) costs $1,800,000 and is expected
—TABLE 5—
Program in Increasing Order of
Cost-Effectiveness Ratios
Program
C
F
H
K
E
J
A
D
I
B
G
QALYs Saved
500
500
200
250
100
50
100
100
150
100
100
Cost
(in dollars)
1,000,000
2,000,000
1,200,000
2,000,000
1,200,000
800,000
1,800,000
2,200,000
4,500,000
5,000,000
10,000,000
Cost per QALY
(in dollars)
2,000
4,000
6,000
8,000
12,000
16,000
18,000
22,000
30,000
50,000
100,000
Ranking
1
2
3
4
5
6
7
8
9
10
11
Cumulative
QALYs Saved Cost (in dollars)
500 1,000,000
1,000 3,000,000
1,200 4,200,000
1,450 6,200,000
1,550 7,400,000
1,600 8,200,000
1,700 10,000,000
1,800 12,200,000
1,950 16,700,000
2,050 21,700,000
2,150 31,700,000
