Cost-Value Analysis in Health Care: Making Sense Out of QALYS Book

	List of Tables and Figures
	Preface and Acknowledgments
	Overview
	Reader's Guide
1	Maximizing Value in Health Care	1
1.1	Introduction	1
1.2	The rationale for numerical measures of value	2
1.3	Available numerical measures of value	4
2	Three Basic Issues in Economic Evaluation	7
2.1	At which levels of decision may economic evaluation be helpful?	7
2.2	Values when caring for others versus values when thinking about self-interest	8
2.3	Resource allocation across programs is essentially about making person trade-offs	13
Appendix	Welfare economics and person trade-offs	15
3	QALYs	18
3.1	What are QALYs?	18
3.2	Two major problems with QALYs	21
4	Concerns for Fairness	23
4.1	What is fairness?	23
4.2	QALYs and fairness	23
4.3	Fairness and gains in utility	26
4.4	Ways of measuring concerns for fairness	30
4.5	Societal concerns for severity	32
4.6	Rules of thumb concerning severity	37
4.7	Societal concerns for realizing potentials for health	38
4.8	Rules of thumb concerning severity and potentials for health	42
4.9	The self-interest perspective behind a veil of ignorance	43
4.10	The degree of error in utility-based predictions of societal preferences	47
4.11	The importance of the duration of a treatment effect	50
4.12	Does discounting for time preference solve the duration problem?	55
4.13	The importance of age	57
4.14	The importance of cost/the number of people helped	61
4.15	The importance of the chance of successful treatment	70
4.16	Summary	73
4.17	Are better weights or additional equity weights a solution?	74
5	The Limitations of Utility Measurement	79
5.1	Ex ante or ex post utilities?	80
5.2	Whom to ask	82
5.3	How to ask	90
6	Ways to Go	113
6.1	The problems	113
6.2	The person trade-off issue revisited	115
6.3	Acknowledging the value of disabled people's lives	118
6.4	Disability Adjusted Life Years (DALYs)	121
6.5	Toward cost-value analysis	123
6.6	Constructing a comprehensive value table	127
6.7	Measurement problems	128
6.8	The relevance of cost-value analysis in practical decision making	132
6.9	Conclusion	141
	Annex: An Example of Cost-Value Analysis	143
	References	146
	Index	155