scholarly journals Ethical Issues Which Have Prevented the U.S. from Maximizing Quality of Life Years

2021 ◽  
Author(s):  
Sage Arbor
Keyword(s):  
Quality Of Life ◽  
Ethical Issues ◽  
Cost Transparency ◽  
Societal Norms ◽  
Life Years ◽  
Healthcare Interventions ◽  
The Cost ◽  
Quality Adjusted Life ◽  
The U.S

The cost of healthcare interventions varies greatly with age, with a significant fraction of cost being spent in the last two years of life. Treating a child can save orders of magnitude more life-years than an octogenarian treated for the same disease, such as cancer. While Quality-Adjusted Life Years (QALYs) can be used to plan a roadmap for how resources should be expended to maximize quality of life the execution of those plans often fail due to societal norms which trump the carefully measured QALYs, resulting in lowered average number and/or quality of years lived. The ethical issues concerning age, sex, lifestyle (smoking, drinking, obesity), cost transparency, and extreme examples (war, population explosion vs. collapse) will be discussed.

scholarly journals Patients with unilateral transfemoral amputation treated with a percutaneous osseointegrated prosthesis

2018 ◽  
Vol 100-B (4) ◽  
pp. 527-534 ◽  
Author(s):  
E. Hansson ◽  
K. Hagberg ◽  
M. Cawson ◽  
T. H. Brodtkorb
Keyword(s):  
Quality Of Life ◽  
Prospective Clinical Study ◽  
Quality Adjusted Life Years ◽  
Transfemoral Amputation ◽  
Healthcare Perspective ◽  
Life Years ◽  
The Cost ◽  
The Impact ◽  
Quality Adjusted Life

Aims The aim of this study was to compare the cost-effectiveness of treatment with an osseointegrated percutaneous (OI-) prosthesis and a socket-suspended (S-) prosthesis for patients with a transfemoral amputation. Patients and Methods A Markov model was developed to estimate the medical costs and changes in quality-adjusted life-years (QALYs) attributable to treatment of unilateral transfemoral amputation over a projected period of 20 years from a healthcare perspective. Data were collected alongside a prospective clinical study of 51 patients followed for two years. Results OI-prostheses had an incremental cost per QALY gained of €83 374 compared with S-prostheses. The clinical improvement seen with OI-prostheses was reflected in QALYs gained. Results were most sensitive to the utility value for both treatment arms. The impact of an annual decline in utility values of 1%, 2%, and 3%, for patients with S-prostheses resulted in a cost per QALY gained of €37 020, €24 662, and €18 952, respectively, over 20 years. Conclusion From a healthcare perspective, treatment with an OI-prosthesis results in improved quality of life at a relatively high cost compared with that for S-prosthesis. When patients treated with S-prostheses had a decline in quality of life over time, the cost per QALY gained by OI-prosthesis treatment was considerably reduced. Cite this article: Bone Joint J 2018;100-B:527–34.

Utilities and Quality-Adjusted Life Years

1989 ◽  
Vol 5 (4) ◽  
pp. 559-575 ◽  
Author(s):  
George W. Torrance ◽  
David Feeny
Keyword(s):  
Quality Of Life ◽  
Cost Utility ◽  
Health Improvement ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Quality Adjustment ◽  
Life Years ◽  
Quality Adjusted Life ◽  
Broad Overview

Utilities and quality-adjusted life years (QALYs) are reviewed, with particular focus on their use in technology assessment. This article provides a broad overview and perspective on these two techniques and their interrelationship, with reference to other sources for details of implementation. The historical development, assumptions, strengths/weaknesses, and applications of each are summarized.Utilities are specifically designed for individual decision-making under uncertainty, but, with additional assumptions, utilities can be aggregated across individuals to provide a group utility function. QALYs are designed to aggregate in a single summary measure the total health improvement for a group of individuals, capturing improvements from impacts on both quantity of life and quality of life– with quality of life broadly defined. Utilities can be used as the quality-adjustment weights for QALYs; they are particularly appropriate for that purpose, and this combination provides a powerful and highly useful variation on cost-effectiveness analysis known as cost-utility analysis.

scholarly journals Pharmacoeconomics in Africa: needs, prospect and challenges

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Temitope Ben-Ajepe ◽  
Ifechukwu Benedict Nwogu ◽  
Damilola Quazeem Olaoye ◽  
Abdulhafeez Ayodele Mustapha ◽  
Theogene Uwizeyimana ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Limited Resources ◽  
African Countries ◽  
Continuous Increase ◽  
Poverty Threshold ◽  
Therapy Choice ◽  
Medication Selection ◽  
Healthcare Interventions ◽  
The Cost

AbstractAfrica as a continent has experienced a continuous increase in the cost of healthcare as its demands increase. With many of these African countries living below the poverty threshold, Africans continue to die from preventable and curable diseases. Population increases have led to an increase in demands for healthcare, which unfortunately have been met with inequitable distribution of drugs. Hence, the outcomes from healthcare interventions are frequently not maximized. These problems notably call for some economic principles and policies to guide medication selection, procurement, or donation for population prioritization or health insurance. Pharmacoeconomics drives efficient use of scarce or limited resources to maximize healthcare benefits and reduce costs. It also brings to play tools that rate therapy choice based on the quality of life added to the patient after a choice of intervention was made over an alternative. In this paper, we commented on the needs, prospect, and challenges of pharmacoeconomics in Africa.

scholarly journals Cost-Effectiveness of Continuous Positive Airway Pressure Therapy in Patients with Obstructive Sleep Apnea-Hypopnea in British Columbia

2008 ◽  
Vol 15 (3) ◽  
pp. 159-165 ◽  
Author(s):  
MCY Tan ◽  
NT Ayas ◽  
A Mulgrew ◽  
L Cortes ◽  
JM FitzGerald ◽  
...  
Keyword(s):  
Quality Of Life ◽  
British Columbia ◽  
Cost Effectiveness ◽  
Quality Adjusted Life Year ◽  
Third Party ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
The Cost ◽  
Quality Adjusted Life

BACKGROUND: Obstructive sleep apnea-hypopnea (OSAH) is a common disorder characterized by recurrent collapse of the upper airway during sleep. Patients experience a reduced quality of life and an increased risk of motor vehicle crashes (MVCs). Continuous positive airway pressure (CPAP), which is the first-line therapy for OSAH, improves sleepiness, vigilance and quality of life.OBJECTIVE: To assess the cost-effectiveness of CPAP therapy versus no treatment for OSAH patients who are drivers.METHODS: A Markov decision analytical model with a five-year time horizon was used. The study population consisted of male and female patients, between 30 and 59 years of age, who were newly diagnosed with moderate to severe OSAH. The model evaluated the cost-effectiveness of CPAP therapy in reducing rates of MVCs and improving quality of life. Utility values were obtained from previously published studies. Rates of MVCs under the CPAP and no CPAP scenarios were calculated from Insurance Corporation of British Columbia data and a systematic review of published studies. MVCs, equipment and physician costs were obtained from the British Columbia Medical Association, published cost-of-illness studies and the price lists of established vendors of CPAP equipment in British Columbia. Findings were examined from the perspectives of a third-party payer and society.RESULTS: From the third-party payer perspective, CPAP therapy was more effective but more costly than no CPAP (incremental cost-effectiveness ratio [ICER] of $3,626 per quality-adjusted life year). From the societal perspective, the ICER was similar ($2,979 per quality-adjusted life year). The ICER was most dependent on preference elicitation method used to obtain utility values, varying almost sixfold under alternative assumptions from the base-case analysis.CONCLUSION: After considering costs and impact on quality of life, as well as the risk of MVCs in individuals with OSAH, CPAP therapy for OSAH patients is a highly efficient use of health care resources. Provincial governments who do not provide funding for CPAP therapy should reconsider.

Quality of life and quality-adjusted life years of chronic schistosomiasis mansoni patients in Brazil in 2015

2018 ◽  
Vol 112 (5) ◽  
pp. 238-244
Author(s):  
Gilmara Lima Nascimento ◽  
Ana Lúcia Coutinho Domingues ◽  
Ricardo Arraes de Alencar Ximenes ◽  
Alexander Itria ◽  
Luciane Nascimento Cruz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Quality Adjusted Life Years ◽  
Schistosomiasis Mansoni ◽  
Life Years ◽  
Quality Adjusted Life

scholarly journals The Use of “Quality-Adjusted Life Years” (QALYs) to Evaluate Treatment in Intensive Care

1995 ◽  
Vol 23 (3) ◽  
pp. 322-331 ◽  
Author(s):  
R. K. Kerridge ◽  
P. P. Glasziou ◽  
K. M. Hillman
Keyword(s):  
Quality Of Life ◽  
Patient Outcome ◽  
Intensive Care ◽  
Pulmonary Oedema ◽  
Trauma Patients ◽  
Quality Adjusted Life Years ◽  
Economic Justification ◽  
Life Years ◽  
Quality Adjusted Life

This study examines the feasibility of using Quality-Adjusted Life Years (QALYs) to assess patient outcome and the economic justification of treatment in an Intensive Care Unit (ICU). 248 patients were followed for three years after admission. Survival and quality of life for each patient was evaluated. Outcome for each patient was quantified in discounted Quality-Adjusted Life Years (dQALYs). The economic justification of treatment was evaluated by comparing the total and marginal cost per dQALY for this patient group with the published cost per QALY for other medical interventions. 150 patients were alive after three years. Quality of life for most longterm survivors was good. Patient outcome (QALYs) was greatest for asthma and trauma patients, and least for cardiogenic pulmonary oedema. The tentative estimated cost- effectiveness of treatment varied from AUD $297 per QALY for asthma to AUD $2323 per QALY for patients with pulmonary oedema. This compares favourably with many preventative and non-acute medical treatments. Although the methodology is developmental, the measurement of patient outcome using QALYs appears to be feasible in a general hospital ICU.

Comparative effectiveness of treatment options for pediatric craniopharyngiomas

2014 ◽  
Vol 13 (2) ◽  
pp. 178-188 ◽  
Author(s):  
Zarina S. Ali ◽  
Robert L. Bailey ◽  
Lawrence B. Daniels ◽  
Venus Vakhshori ◽  
Daniel J. Lewis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Surgical Approaches ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Subtotal Removal ◽  
Quality Adjusted Life

Object No clear treatment guidelines for pediatric craniopharyngiomas exist. The authors developed a decision analytical model to evaluate outcomes of 4 surgical approaches for craniopharyngiomas in children, including attempted gross-total resection (GTR), planned subtotal removal plus radiotherapy, biopsy plus radiotherapy, and endoscopic resections of all kinds. Methods Pooled data, including the authors' own experience, were used to create evidence tables, from which incidence, relative risks, and summary outcomes in quality-adjusted life years (QALYs) were calculated for the 4 management strategies. Results Quality-adjusted life years at the 5-year follow-up were 2.3 ± 0.1 for attempted GTR, 2.9 ± 0.2 for planned subtotal removal plus radiotherapy, 3.9 ± 0.2 for biopsy plus radiotherapy, and 3.7 ± 0.2 for endoscopic resection (F = 17,150, p < 0.001). Similarly, QALYs at 10-year follow-up were 4.5 ± 0.2 for attempted GTR, 5.7 ± 0.5 for planned subtotal removal plus radiotherapy, and 7.8 ± 0.5 for biopsy plus radiotherapy (F = 6,173, p < 0.001). On post hoc pairwise comparisons, the differences between all pairs compared were also highly significant (p < 0.001). Since follow-up data at 10 years are lacking for endoscopic cases, this category was excluded from 10-year comparisons. Conclusions Biopsy with subsequent radiotherapy is the preferred approach with respect to improved overall quality of life. While endoscopic approaches also show promise in preserving quality of life at five-year follow-up, there are not sufficient data to draw conclusions about this comparison at 10 years.

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