Title: Whose preferences count?
Author: Dolan, Paul
Publisher: edical decision making, 19 (4). pp. 482-486
Abstract: An important consideration when choosing how to allocate health care resources is the improvements in patients’ health-related quality of life (HRQoL) that alternative allocations generate. There is considerable debate about whose preferences should be used when measuring and valuing HRQoL. This debate has usually been in terms of whether the values of patients or the general public are the most appropriate. It is argued in this paper that this is a false dichotomy that does not facilitate understanding of empirical evidence. Nor, more importantly, does it address one of the most important issues in the debate about whose preferences count, that is, whether the fact that many people adapt to poor health states should be taken into account when ascribing values to those states. A conceptual framework is developed to facilitate a more fruitful discussion of the issues relating to the question of whose preferences should count.
Title: Public views on health care rationing: a group discussion study
Authors: Cookson, Richard and Dolan, Paul
Publisher: Health policy, 49 (1-2). pp. 63-74
Abstract: This small-scale study develops a new methodology for investigating which ethical principles of health care rationing the public support after discussion and deliberation. In ten groups of about six people, members of the public are asked to discuss a hypothetical rationing choice, concerning four identified patients who are described in general terms but without detailed information. It is explained to respondents that the purpose of the exercise is to find out what general ethical principles they support. Discussions are chaired by an academic specialising in health policy, whose role is to encourage debate but not actively to participate. On the basis of an innovative qualitative data analysis, which translates what people say into ethical principles identified in the theoretical literature, the public appear to support three main rationing principles: (1) a broad ‘rule of rescue’ that gives priority to those in immediate need, (2) health maximisation and (3) equalisation of lifetime health. To our knowledge, this pluralistic viewpoint on rationing has never been developed into a coherent theoretical position, nor into a quantifiable model that health care managers can use for guidance.
Title: Costs of breast cancer treatment in the United Kingdom
Authors: Dolan, Paul and Torgerson, D. and Wolstenholme, J.
Publisher: The breast, 8 (4). pp. 205-207
Abstract: Breast cancer is a major source of mortality and morbidity to women in the UK. In this paper we estimate the costs of treating breast cancer using random samples of secondary and primary care records. We estimate the average cost per case of breast cancer to be £7247 which gives a total cost of £243 million per annum for the whole of the UK.
Title: Effect of discussion and deliberation on the public’s views of priority setting in health care: focus group study
Authors: Dolan, Paul and Cookson, Richard and Ferguson, Brian
Publisher: British medical journal, 318 (7188). pp. 916-919
Abstract: Objective: To investigate the extent to which people change their views about priority setting in health care as a result of discussion and deliberation. Design: A random sample of patients from two urban general practices was invited to attend two focus group meetings, a fortnight apart. Setting: North Yorkshire Health Authority. Subjects: 60 randomly chosen patients meeting in 10 ugroups of five to seven people. Main outcome measures: Differences between people’s views at the start of the first meeting and at the end of the second meeting, after they have had an opportunity for discussion and deliberation, measured by questionnaires at the start of the first meeting and the end of the second meeting. Results: Respondents became more reticent about the role that their views should play in determining priorities and more sympathetic to the role that healthcare managers play. About a half of respondents initially wanted to give lower priority to smokers, heavy drinkers, and illegal drug users, but after discussion many no longer wished to discriminate against these people. Conclusion: The public’s views about setting priorities in health care are systematically different when they have been given an opportunity to discuss the issues. If the considered opinions of the general public are required, surveys that do not allow respondents time or opportunity for reflection may be of doubtful value.
Title: Health-related quality of life of Colles’ fracture patients
Authors: Dolan, Paul and Torgerson, D. and Kumar Kakarlapudi, T
Publisher: Osteoporosis international , 9 (3). pp. 196-199
Abstract: Recent guidelines published by the National Osteoporosis Foundation (NOF) make extensive use of quality-adjusted life-years (QALYs). Crucial to these guidelines, therefore, are the assumptions that are made about the health-related quality of life (HRQoL) gained from the avoidance of osteoporotic fractures. This paper reports on a study in which 50 Colles’ fracture patients were asked to describe their health at each visit during treatment using the EuroQol descriptive system and to value their own health using the visual analogue scale (VAS). By applying a set of population-derived valuations to the states reported by the patients, the QALY loss is shown to be about 2%. This is about half of the loss, based upon clinician judgement, that is contained in the NOF guidelines. In addition, the results suggest that it may be possible to use VAS scores to predict treatment requirements, since those patients who require fewer visits have, on average, higher initial VAS scores.