Valuing health-related quality of life: issues and controversies

Title: Valuing health-related quality of life: issues and controversies
Author: Dolan, Paul
Publisher: Pharmacoeconomics, 15 (2). pp. 119-127
ISSN:1170-7690
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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: * what is to be valued?; * how is it to be valued?; and * 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.

Using the person trade-off approach to examine differences between individual and social values

Title: Using the person trade-off approach to examine differences between individual and social values
Authors: Dolan, Paul and Green, Colin
Publisher: Health economics, 7 (4). pp. 307-312
ISSN: 1057-9230
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Abstract: Health state valuations, elicited by methods such as the standard gamble and the time trade-off, give an indication of the value that an individual attaches to particular health states. As measures of individual values, it has been argued that such valuations serve as poor proxies for social preferences, which, it is suggested, are a function of other factors, such as the initial severity of the patient’s health state. The person trade-off (PTO) method has been proposed as a technique which takes account of many of these other factors. This paper reports on a study using the PTO to investigate whether an individual’s preferences over treatments for themselves differ from their preferences when they are asked to think about the treatment of other people. The results suggest that there is indeed a difference, although qualitative data suggests that health gain is an important determinant of social value. This latter finding runs counter to those of a number of other studies which suggest that concerns about pre-treatment severity are as, if not more, important. Possible explanations for the differences are put forward.

Variations in population health status: results from a UK survey

Title: Variations in population health status: results from a UK survey
Authors: Kind, Paul and Dolan, Paul and Gudex, Claire and Williams, Alan
Publisher: British medical journal, 316 (7133)
ISSN: 0959-8138
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Abstract: Objective: To measure the health of a representative sample of the population of the United Kingdom by using the EuroQoL EQ-5D questionnaire. Design: Stratified random sample representative of the general population aged 18 and over and living in the community. Setting: United Kingdom. Subjects: 3395 people resident in the United Kingdom. Main outcome measures: Average values for mobility, self care, usual activities, pain or discomfort, and anxiety or depression. Results: One in three respondents reported problems with pain or discomfort. There were differences in the perception of health according to the respondent’s age, social class, education, housing tenure, economic position, and smoking behaviour. Conclusions: The EQ-5D questionnaire is a practical way of measuring the health of a population and of detecting differences in subgroups of the population.

The measurement of individual utility and social welfare

Title: The measurement of individual utility and social welfare
Author: Dolan, Paul
Publisher: Journal of health economics, 17 (1). pp. 39-52
ISSN: 0167-6296
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Abstract: It has been suggested by a number of economists that decisions about how to allocate scarce health care resources should be informed by the cost per quality-adjusted life-years (QALYs) of the different alternatives. One of the criticisms of the QALY approach is that it is based on the measurement of individual utility; yet the values elicited are used to inform social choice. In this respect, it is argued that the QALY approach fails to take account of distributional issues that are known to be important in the context of health care. This paper addresses this issue and presents an approach grounded in microeconomic theory that is flexible enough to deal with a wide range of efficiency-equity trade-offs, while making the nature of the trade-off transparent. In addition, it is an approach that is relatively simple to investigate empirically, and the results of a preliminary study are presented as illustration of this.

Prescribing by general practitioners after an osteoporotic fracture

Title: Prescribing by general practitioners after an osteoporotic fracture
Authors: Torgerson, D. J and Dolan, Paul
PublisherAnnals of the rheumatic diseases, 57 (6). pp. 378-379.
ISSN: 0003-4967
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Abstract: OBJECTIVES Osteoporosis is a major cause of morbidity and cost. Patients sustaining one osteoporotic fracture are at increased risk of having another fracture. The objective of this study was to examine the use of “bone drugs” for the prevention of further osteoporotic fractures among patients who have had a “typical” osteoporotic fracture. METHODS This study took a random sample of 300 women aged 50 and over who had sustained either a vertebral, hip or Colles fracture in 1995 from the General Practice Research Database (GPRD) and compared their use of bone drugs with 300 age and practice matched controls. RESULTS Compared with age and practice matched control patients only vertebral fracture patients showed a statistically significant increase in the use of bone drugs in the year after fracture (39% and 2% for cases and controls respectively; 95% CI of difference 27% to 47%). Etidronate was the most commonly used compound. CONCLUSION The majority of patients sustaining an osteoporotic fracture are not prescribed any pharmaceutical agents for the secondary prevention of fracture one year after a primary fracture.

On the contingent valuation of safety and the safety of contingent valuation: part 1-caveat investigator

Title: On the contingent valuation of safety and the safety of contingent valuation: part 1-caveat investigator
Authors: Beattie, Jane and Covey, Judith and Dolan, Paul and Hopkins, Lorraine and Jones-Lee, Michael and Loomes, G. and Pidgen, Nick and Robinson, Angela and Spencer, Anne
Publisher: Journal of risk and uncertainty, 17 (1). pp. 5-26
ISSN: 0895-5646
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Abstract: This article reports the results of two studies aimed at testing and refining a procedure for estimating willingness to pay based monetary values of safety using the contingent valuation method. In spite of the fact that respondents were given the opportunity to discuss various safety issues and key concepts in focus group meetings held in advance of individual interviews, and were also given ample opportunity to revise their responses in the light of the overall pattern of these responses, the results show clear evidence of extensive and persistent insensitivity to the scale and scope of the safety improvements that were specified in the contingent valuation questions, as well as vulnerability to framing effects. This clearly casts serious doubt on the reliability and validity of willingness-to-pay based monetary values of safety estimated using conventional contingent valuation procedures.

The cost of treating osteoporotic fractures in the UK female population

Title: The cost of treating osteoporotic fractures in the UK female population
Authors: Dolan, Paul and Torgerson, D. J.
Publisher: Osteoporosis international , 8 (6). pp. 611-617
ISSN: 0937-941X
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Abstract: Osteoporotic fractures represent a significant burden to society. The costs of osteoporotic fractures to the UK health care system have not previously been accurately described. In this paper, we quantify the health care and social care costs of fractures occurring in women aged 50 years and over in the UK. We used a variety of data sources. For acute hospital hip fracture costs existing published estimates were used whilst for social care costs a survey of resource use among fracture patients before and after hip fracture was utilized. We undertook a case-control study using the General Practice Research Database to estimate primary care costs. From these data we estimated that the cost of a hip fracture is about 12,000 Pounds, with non-acute hospital costs representing the larger proportion. The other fractures were less expensive, at 468 Pounds, 479 Pounds and 1338 Pounds for wrist, vertebral and other fractures, respectively. For all fractures the annual cost to the UK is 727 million Pounds. Assuming each male hip fracture costs the same as a female fracture, including these would increase the total costs to 942 million Pounds.