Results for 'QALY'

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  1. Calibrating QALYs to Respect Equality of Persons.Donald Franklin - 2016 - Utilitas 29 (1):1-23.
    Comparative valuation of different policy interventions often requires interpersonal comparability of benefit. In the field of health economics, the metric commonly used for such comparison, quality adjusted life years (QALYs) gained, has been criticized for failing to respect the equality of all persons’ intrinsic worth, including particularly those with disabilities. A methodology is proposed that interprets ‘full quality of life’ as the best health prospect that is achievable for the particular individual within the relevant budget constraint. This calibration is challenging (...)
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  2.  80
    QALYs, euthanasia and the puzzle of death.Stephen Barrie - 2015 - Journal of Medical Ethics 41 (8):635-638.
    This paper considers the problems that arise when death, which is a philosophically difficult concept, is incorporated into healthcare metrics, such as the quality-adjusted life year (QALY). These problems relate closely to the debate over euthanasia and assisted suicide because negative QALY scores can be taken to mean that patients would be ‘better off dead’. There is confusion in the literature about the meaning of 0 QALY, which is supposed to act as an ‘anchor’ for the surveyed (...)
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  3.  46
    Castigating QALYs.J. Rawles - 1989 - Journal of Medical Ethics 15 (3):143-147.
    The ethical problem of how to apportion limited resources amongst the needy has been forced on us by arbitrary limitation of health expenditure. Its solution would not be required if health expenditure were higher. Distribution of resources according to best value for money, assessed as Quality Adjusted Life Years (QALYs) per unit cost, has been suggested as a possible solution, but leads to absurd anomalies. In the calculation of QALYs the implied value of life is no more than the absence (...)
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  4.  59
    QALYS and the integration of claims in health care rationing.Paul Anand - 1999 - Health Care Analysis 7 (3):239-253.
    The paper argues against the polarisation of the health economics literature into pro- and anti-QALY camps. In particular, we suggest that a crucial distinction should be made between the QALY measure as a metric of health, and QALY maximisation as an applied social choice rule. We argue against the rule but for the measure and that the appropriate conceptualisation of health-care rationing decisions should see the main task as the integration of competing and possibly incommensurable normative claim (...)
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  5.  79
    Economics, QALYs and Medical Ethics–a Health Economist's Perspective.Alan Williams - 1995 - Health Care Analysis 3 (3):221-226.
    This paper explores how medical practice ought to be conducted, in the face of scarcity, if our objective is to maximise the benefits of health. After explaining briefly what the cost-per-QALY criterion means, a series of ethical objections to it are considered one by one. The objectors fall into four groups: a. those who reject all collective priority-setting as unethical; b. those who accept the need for collective priority-setting, but believe it is contrary to medical ethics; c. those who (...)
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  6.  19
    Precision QALYs, Precisely Unjust.Leonard M. Fleck - 2019 - Cambridge Quarterly of Healthcare Ethics 28 (3):439-449.
    Warwick Heale has recently defended the notion of individualized and personalized Quality-Adjusted Life Years in connection with health care resource allocation decisions. Ordinarily, QALYs are used to make allocation decisions at the population level. If a health care intervention costs £100,000 and generally yields only two years of survival, the cost per QALY gained will be £50,000, far in excess of the £30,000 limit per QALY judged an acceptable use of resources within the National Health Service in the (...)
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  7.  82
    Calculating qalys: Liberalism and the value of health states.Douglas MacKay - 2017 - Economics and Philosophy 33 (2):259-285.
    The value of health states is often understood to depend on their impact on the goodness of people's lives. As such, prominent health states metrics are grounded in particular conceptions of wellbeing – e.g. hedonism or preference satisfaction. In this paper, I consider how liberals committed to the public justification requirement – the requirement that public officials choose laws and policies that are justifiable to their citizens – should evaluate health states. Since the public justification requirement prohibits public officials from (...)
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  8.  41
    Lifetime QALY prioritarianism in priority setting.Trygve Ottersen - 2013 - Journal of Medical Ethics 39 (3):175-180.
    Two principles form the basis for much priority setting in health. According to the greater benefit principle, resources should be directed toward the intervention with the greater health benefit. According to the worse off principle, resources should be directed toward the intervention benefiting those initially worse off. Jointly, these principles accord with so-called prioritarianism. Crucial for its operationalisation is the specification of the worse off. In this paper, we examine how the worse off can be defined as those with the (...)
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  9.  16
    QALYs, Disability Discrimination, and the Role of Adaptation in the Capacity to Recover: The Patient-Sensitive Health-Related Quality of Life Account.Julia Mosquera - 2023 - Cambridge Quarterly of Healthcare Ethics 32 (2):154-162.
    Quality-Adjusted Life Years (QALYs) and Disability-Adjusted Life Years (DALYs) are two of the most commonly used health measures to determine resource prioritization and the population burden of disease, respectively. There are different types of problems with the use of QALYs and DALYs for measuring health benefits. Some of these problems have to do with measurement, for example, the weights they ascribe to health states might fail to reflect with exact accuracy the actual well-being or health levels of individuals. But even (...)
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  10.  41
    QALYs—A Threat to our Quality of Life?Anne Haydock - 1992 - Journal of Applied Philosophy 9 (2):183-188.
    QALY calcuations are currently being considered in the UK as a way of showing how the National Health Service (NHS) can do the most good with its resources. After providing a brief summary of how QALY calculations work and the most common arguments for and against using them to set NHS priorities, I suggest that they are an inadequate measure of the good done by the NHS because they refer only to its effects on what will be defined (...)
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  11.  48
    The QALY argument: a physician's and a philosopher's view.J. Rawles & K. Rawles - 1990 - Journal of Medical Ethics 16 (2):93-94.
    The arguments used by Gavin Mooney in his scornful response to Castigating QALYs, are examined. In spite of the rhetoric there is a broad measure of agreement about the deficiencies of QALYs as a means of distributing scarce resources. The main area of conflict is that John Rawles favours compaigning for more resources while Gavin Mooney, constrained by his remit as a health economist, favours acceptance of the present level of funding and better methods of distributing resources.
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  12.  89
    QALYs, age and fairness.Klemens Kappel & Peter Sandøe - 1992 - Bioethics 6 (4):297–316.
  13. Good, Fairness and QALYs.John Broome - 1988 - Royal Institute of Philosophy Lecture Series 23 (1):57-73.
    Counting QALYs (quality adjusted life years) has been proposed as a way of deciding how resources should be distributed in the health service: put resources where they will produce the most QALYs. This proposal has encountered strong opposition. There has been a disagreement between some economists favouring QALYs and some philosophers opposing them. But the argument has, I think, mostly been at cross-purposes. Those in favour of QALYs point out what they can do, and those against point out what they (...)
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  14.  18
    A QALY is [still] a QALY is [still] a QALY?Hamideh Mahdiani, Nikolai Münch & Norbert W. Paul - 2024 - BMC Medical Ethics 25 (1):1-6.
    Despite clinical evidence of drug superiority, therapeutic modalities, like combination immunotherapy, are mostly considered cost-ineffective due to their high costs per life year(s) gained. This paper, taking an ethical stand, reevaluates the standard cost-effectiveness analysis with that of the more recent justice-enhanced methods and concludes by pointing out the shortcomings of the current methodologies.
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  15.  23
    QALYs: are they enough? A health economist's perspective.G. Mooney - 1989 - Journal of Medical Ethics 15 (3):148-152.
    John Rawles's criticism of QALYs are seen as being both imprecise and largely unhelpful. This paper accepts that there are problems in both QALYs themselves and in the current decision-making processes with which they seek to help. The QALY pliers tend to play down the former and the QALY knockers the latter. It is suggested that theories (regret theory and prospect theory) other than expected utility theory, which is normally seen as the basis for QALYs, may provide better (...)
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  16.  28
    QALYs, lotteries and veils: the story so far.T. Hope - 1996 - Journal of Medical Ethics 22 (4):195-196.
  17.  11
    Ethical Shortcomings of QALY: Discrimination Against Minorities in Public Health.Gabriel Andrade - forthcoming - Cambridge Quarterly of Healthcare Ethics:1-8.
    Despite progress, discrimination in public health remains a problem. A significant aspect of this problem relates to how medical resources are allocated. The paradigm of quality-adjusted-life-year (QALY) dictates that medical resources should be allocated on the basis of units measured as length of life and quality of life that are expected after the implementation of a treatment. In this article, I discuss some of the ethical shortcomings of QALY, by focusing on some of its flawed moral aspects, as (...)
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  18.  10
    Using QALYs to allocate resources: A critique of some objections.Lesley McTurk - 1994 - Monash Bioethics Review 13 (1):22-33.
  19. QALY: An Ethical Issue that Dare Not Speak its Name.Peter Hirskyj - 2007 - Nursing Ethics 14 (1):72-82.
    The current British Government's policy towards resource allocation for health care has been informed by the commissioned Wanless Report. This makes a case for the use of quality adjusted life years (QALYs) to form a rationale for resourcing health care and has implications for the staff and patients who work in and use the health service. This article offers a definition of the term ‘QALY’ and considers some of the strengths and weaknesses of this approach to resource distribution. An (...)
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  20.  26
    Unprincipled QALYs: a response to Cubbon.J. Harris - 1991 - Journal of Medical Ethics 17 (4):185-188.
  21.  31
    Unprincipled QALYs: a response to Harris.J. Cubbon - 1992 - Journal of Medical Ethics 18 (2):100-100.
  22.  47
    QALYs, lotteries and veils.J. Davies - 1997 - Journal of Medical Ethics 23 (2):119-119.
  23.  55
    Palliative Care and the QALY Problem.Jonathan Hughes - 2005 - Health Care Analysis 13 (4):289-301.
    Practitioners of palliative care often argue for more resources to be provided by the state in order to lessen its reliance on charitable funding and to enable the services currently provided to some of those with terminal illnesses to be provided to all who would benefit from it. However, this is hard to justify on grounds of cost-effectiveness, since it is in the nature of palliative care that the benefits it brings to its patients are of short duration. In particular, (...)
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  24.  18
    Economics, QALYs and medical ethics: A practical agenda? [REVIEW]Ray Robinson - 1995 - Health Care Analysis 3 (3):229-232.
  25.  28
    In Defence of QALYs.Stephen Mcdonnell - 1994 - Journal of Applied Philosophy 11 (1):89-98.
    A recent article has claimed that one of the significant benefits which people in the UK derive from the existence of the National Health Service must be lost if the Service adopts the QALY maximisation principle to allocate medical resources. The argument fails, partly because its author conflates two distinct benefits. The first is almost certainly important, but there is no reason to believe that it would be lost if the principle were introduced (while there is some reason to (...)
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  26.  38
    Against lifetime QALY prioritarianism.Anders Herlitz - 2018 - Journal of Medical Ethics 44 (2):109-113.
    Lifetime quality-adjusted life-year (QALY) prioritarianism has recently been defended as a reasonable specification of the prioritarian view that benefits to the worse off should be given priority in health-related priority setting. This paper argues against this view with reference to how it relies on implausible assumptions. By referring to lifetime QALY as the basis for judgments about who is worse off lifetime QALY prioritarianism relies on assumptions of strict additivity, atomism and intertemporal separability of sublifetime attributes. These (...)
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  27.  37
    Unprincipled QALYs.J. Harris - 1992 - Journal of Medical Ethics 18 (3):162-162.
  28. The principle of QALY maximisation as the basis for allocating health care resources.J. Cubbon - 1991 - Journal of Medical Ethics 17 (4):181-184.
    This paper presents a case for allocating health care resources so as to maximise Quality Adjusted Life Years (QALYs). Throughout parallels are drawn with the grounds for adopting utilitarianism. QALYs are desirable because they are essential for human flourishing and goal-attainment. In conditions of scarcity the principle of QALY maximisation may involve unequal treatment of different groups of people; and it is argued that this is not objectionable. Doctors in their dealings with patients should not be continually consulting the (...)
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  29. Preferences, needs and QALYs.J. Cohen - 1996 - Journal of Medical Ethics 22 (5):267-272.
    Quality Adjusted Life Years (QALYs) have become a household word among health economists. Their use as a means of comparing the value of health programmes and medical interventions has stirred up controversy in the medical profession and the academic community. In this paper, I argue that QALY analysis does not adequately take into account the differentiated nature of the health state values it measures. Specifically, it does not distinguish between needs and preferences with respect to its valuation of health (...)
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  30. The value of QALYs.Alan Williams - 2012 - In Stephen Holland (ed.), Arguing About Bioethics. Routledge. pp. 423.
  31. Bursting Bubbles? QALYs and Discrimination.Ben Davies - 2019 - Utilitas 31 (2):191-202.
    The use of Quality-Adjusted Life Years (QALYs) in healthcare allocation has been criticized as discriminatory against people with disabilities. This article considers a response to this criticism from Nick Beckstead and Toby Ord. They say that even if QALYs are discriminatory, attempting to avoid discrimination – when coupled with other central principles that an allocation system should favour – sometimes leads to irrationality in the form of cyclic preferences. I suggest that while Beckstead and Ord have identified a problem, it (...)
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  32.  56
    Balancing principles, QALYs and the straw men of resource allocation.John McMillan & Tony Hope - 2010 - American Journal of Bioethics 10 (4):48 – 50.
    Kerstein and Bognar (2010) and Persad, Wertheimer, and Emanuel (2009) defend specific principles for the allocation of health care resources, but their choice of principles is influenced by the exa...
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  33.  13
    Eine Chance für das QALY? Franz - 2005 - Jahrbuch für Wissenschaft Und Ethik 10 (1):151-161.
  34.  67
    Palliative care for the terminally ill in America: the consideration of QALYs, costs, and ethical issues.Y. Tony Yang & Margaret M. Mahon - 2012 - Medicine, Health Care and Philosophy 15 (4):411-416.
    The drive for cost-effective use of medical interventions has advantages, but can also be challenging in the context of end-of-life palliative treatments. A quality-adjusted life-year (QALY) provides a common currency to assess the extent of the benefits gained from a variety of interventions in terms of health-related quality of life and survival for the patient. However, since it is in the nature of end-of-life palliative care that the benefits it brings to its patients are of short duration, it fares (...)
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  35.  36
    QALYs: Maximisation, distribution and consent. A response to Alan Williams. [REVIEW]Paul T. Menzel - 1995 - Health Care Analysis 3 (3):226-229.
  36.  61
    Double jeopardy and the use of QALYs in health care allocation.P. Singer, J. McKie, H. Kuhse & J. Richardson - 1995 - Journal of Medical Ethics 21 (3):144-150.
    The use of the Quality Adjusted Life-Year (QALY) as a measure of the benefit obtained from health care expenditure has been attacked on the ground that it gives a lower value to preserving the lives of people with a permanent disability or illness than to preserving the lives of those who are healthy and not disabled. The reason for this is that the quality of life of those with illness or disability is ranked, on the QALY scale, below (...)
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  37.  17
    Cost-Value Analysis in Health Care: Making Sense Out of Qalys.Erik Nord - 1999 - Cambridge University Press.
    This book is a comprehensive account of what it means to try to quantify health in distributing resources for health care. It examines the concept of QALYs which supposedly makes it more accurate to talk about life in terms of both quality and quantity of years lived when referring to health care policy. It offers an elegant new approach to comparing the costs and benefits of medical interventions. Cost-Utility Analysis is a method designed by economists to aid decision makers distribute (...)
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  38.  59
    Allocating Healthcare By QALYs: The Relevance of Age.John McKie, Helga Kuhse, Jeff Richardson & Peter Singer - 1996 - Cambridge Quarterly of Healthcare Ethics 5 (4):534.
    What proportion of available healthcare funds should be allocated to hip replacement operations and what proportion to psychiatric care? What proportion should go to cardiac patients and what to newborns in intensive care? What proportion should go to preventative medicine and what to treating existing conditions? In general, how should limited healthcare resources be distributed If not all demands can be met?
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  39. Cost-Value Analysis in Health Care: Making Sense out of QALYs.Erik Nord - 2001 - Philosophical Quarterly 51 (202):132-133.
    This book is a comprehensive account of what it means to try to quantify health in distributing resources for health care. It examines the concept of QALYs which supposedly makes it more accurate to talk about life in terms of both quality and quantity of years lived when referring to health care policy. It offers an elegant new approach to comparing the costs and benefits of medical interventions. Cost-Utility Analysis is a method designed by economists to aid decision makers distribute (...)
     
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  40.  20
    Improved health state descriptions will not benefit disabled patients under QALY-based assessment.Sean Sinclair - 2018 - Journal of Medical Ethics 44 (11):797-798.
    I would like to thank Whitehurst et al for their comments on my paper.1 Although I will argue their approach will not eliminate the potential for disability discrimination from quality-adjusted life year -based assessment, their comments were very thought provoking. Whitehurst et al argue that, to the extent that allocating healthcare by QALYs discriminates against disabled patients, the fault is not with the QALY framework, but with ‘the descriptive systems of preference-based health-related quality of life instruments’.1 Specifically, they argue (...)
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  41.  17
    Is the Use of DALYs and QALYs Ethically Permissible in Triage Decisions? COVID-19 and Equity Considerations from a Queer-Crip Perspective.Lautaro Leani & Ignacio Mastroleo - 2023 - Ethic@: An International Journal for Moral Philosophy 22 (1).
    This paper explores the symbolic and material implications of the use of DALYs and QALYs as priority or tie-breaker criteria in triage decisions. It aims to answer the question of their ethical permissibility based on the particular case of the COVID-19 pandemic. For this purpose, theories framed in a queer-crip perspective and ethical frameworks of equity will be used. From a queer-crip perspective, the use of DALYs and QALYs in triage decisions discriminates against and excludes people with disabilities, as it (...)
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  42. The Ethical QALY: Ethical Issues in Healthcare Resource Allocations; The Allocation of Health Care Resources: An Ethical Evaluation of the`QALY' Approach. [REVIEW]Paul Menzel - 1999 - Bioethics 13 (5):436.
  43.  31
    The ethical QALY: ethical issues in healthcare resource allocations. [REVIEW]Julius Sim - 2000 - Nursing Ethics 7 (2):171-172.
    This book is the outcome of a European Commission-funded project on resource allocation in health care. It is co-authored by a philosopher, an epidemiologist, a public health medicine specialist and a health economist. Its range is broad, covering the historical, economic, methodological and philosophical aspects of healthrelated quality of life and its measurement.
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  44. NICE, Alzheimer's and the QALY.J. G. Taylor - 2007 - Clinical Ethics 2 (1):50-54.
    The introduction of National Institute for Health and Clinical Excellence (NICE) guidance on Alzheimer's medication in November 2006 will have a significant effect on the treatment of patients, and is opposed by the Royal College of Psychiatrists and many charities dealing with the elderly. The use of the Quality-Adjusted Life Year (QALY) in the guidance formulation is much debated due to questions of ageism. This article seeks to examine the basis of these accusations and whether NICE can be justified (...)
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  45.  49
    Experienced Utility or Decision Utility for QALY Calculation? Both.Paige A. Clayton & Douglas P. MacKay - 2018 - Public Health Ethics 11 (1):82-89.
    Policy-makers must allocate scarce resources to support constituents’ health needs. This requires policy-makers to be able to evaluate health states and allocate resources according to some principle of allocation. The most prominent approach to evaluating health states is to appeal to the strength of people’s preferences to avoid occupying them, which we refer to as decision utility metrics. Another approach, experienced utility metrics, evaluates health states based on their hedonic quality. In this article, we argue that although decision utility metrics (...)
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  46.  30
    Why the Coming Debate Over the QALY and Disability Will be Different.Steven D. Pearson - 2019 - Journal of Law, Medicine and Ethics 47 (2):304-307.
  47.  84
    The Allocation of Health Care Resources: An Ethical Evaluation of the ‘‘QALY’’ Approach. [REVIEW]Soren Holm - 2000 - Ethics 110 (3):627-628.
    This book contains a sustained defense of the Quality Adjusted Life Years (QALY) approach to resource allocation in health care. According to this approach resources should be allocated in such a way that the number of QALYs gained is maximized. The authors place this approach within a broader preference Utilitarian framework and argue that it is a special case of consequentialism specifically relevant to the health care field. The first two chapters of the book give a basic introduction to (...)
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  48.  26
    Cost-value Analysis in Health Care: Making Sense out of QALYs: Eric Nord, Cambridge, Cambridge University Press, 1999, 175 pages, pound35 (hb) pound11.95 (pb). [REVIEW]J. McMillan - 2001 - Journal of Medical Ethics 27 (2):139-139.
  49.  25
    Cost-value analysis in health care: Making sense out of QALYs, Erik Nord. [REVIEW]Daniel M. Hausman - 2000 - Economics and Philosophy 16 (2):333-378.
  50. Which values should be built into economic measures?S. Andrew Schroeder - 2019 - Economics and Philosophy 35 (3):521-536.
    Many economic measures are structured to reflect ethical values. I describe three attitudes towards this: maximalism, according to which we should aim to build all relevant values into measures; minimalism, according to which we should aim to keep values out of measures; and an intermediate view. I argue the intermediate view is likely correct, but existing versions are inadequate. In particular, economists have strong reason to structure measures to reflect fixed, as opposed to user-assessable, values. This implies that, despite disagreement (...)
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