Valuing the Q in QALYs: Does Providing Patients' Ratings Affect Population Values?

摘要

Objective: Quality-adjusted life years (QALYs) are used to measure the health benefits associated with treatments. QALYs are derived from objective mortality data weighted by assessments made by the general population of the impact on health-related quality of life associated with particular health states. In this study, a simple change is introduced to improve the validity of QALYs by giving raters information about how people living in the health states rate the health states. Method: Participants from the general population (N = 155) judged 3 health states using a standard valuation technique after being randomly allocated to 1 of 2 groups. The intervention group was given patients' mean ratings of their own health states from worst to best imaginable health (0-100 scale) before providing their valuations, while the control group was given this information only after providing their valuations. The participants in both groups also indicated whether patients' mean ratings were higher, broadly similar, or lower than they previously expected. Results: When the mean ratings given by patients were higher (lower) than expected, participants in the intervention group provided significantly higher (lower) valuations than participants in the control group. These findings show that participants adjust their valuations of a health state in the direction of the appraisals of those experiencing that state. Conclusion: Insofar as policymakers are committed to valuing health states using valuations given by people from the general population, it is desirable to elicit more informed values by providing people with information on how patients rate those states.