4 - The value of health

Question 1

what is health related quality of life?

Answer 1

A multidimensional concept that assesses how an individual’s physical, mental, emotional, and social well-being is affected by their health and any healthcare interventions or conditions they may have.

Question 2

what is the EQ-5D’s?

Answer 2

A widely used health-related quality of life (HRQoL) assessment tool and method. Commonly used in healthcare research, clinical trials, and health economics to assess the impact of health conditions and interventions on a person’s well-being. Has five dimensions measured on 3 separate levels (243 different health states total)

Question 3

what are the 5 dimensions measured by the EQ-5D?

Answer 3

Mobility: person’s ability to move about, including activities such as walking, running, or using mobility aids.

Self-Care: person’s ability to perform daily tasks related to personal hygiene and taking care of oneself.

Usual Activities: individual’s ability to carry out their usual activities, such as work, study, housework, or leisure activities.

Pain/Discomfort: extent to which an individual experiences pain or discomfort and how it affects their daily life.

Anxiety/Depression: person’s emotional well-being and psychological state, including feelings of anxiety or depression.

Question 4

What is the rating scale method and its limitations?

Answer 4

A method of evaluating health states by presenting individuals with a vertical scale similar to a thermometer (100 grades with increments of 5 between 0-100, 0 being the worst possible health and 100 the best possible health). Values are then placed on a subjective scale of 0-1 based on an average of responses. Cannot be used to measure improvement of life. Provides little information.

Question 5

explain the standard gamble method

Answer 5

A widely used technique in health economics and health-related research to measure individuals’ preferences and utilities for different health states. Requires asking respondents to make a choice between how long they would choose to live in a health state vs. a treatment that would either restore them to full health with some probability (p) or lead to instant death with a probability of (1-p).

Question 6

what does the standard gamble method reveal when it comes to evaluating health?

Answer 6

Reveals the relative value they place on differences between the health state and full health, and the health state and death. Distorted by peoples risk-attitudes towards different health states.

Question 7

what is the time trade-off method?

Answer 7

Employed to assess health-related quality of life (HRQoL) and to calculate quality-adjusted life years (QALYs), which are used in cost-utility analyses to evaluate the cost-effectiveness of healthcare interventions. Designed to quantify the trade-offs people are willing to make between the length of life and the quality of life when faced with different health conditions. Distorted by people’s perceptions of health in the future..

Question 8

what is a health-adjusted life expectancy?

Answer 8

A population health measure that estimates the average number of years a person can expect to live in full health or without disability or disease. HALE combines information on mortality and morbidity to calculate the expected years of healthy life.

Question 9

what’s the difference between morbidity and mortality?

Answer 9

morbidity = presence of illness/disability

mortality = life expectancy

Question 10

what is QALY?

Answer 10

• An individual-level measure used in health economics to assess the effectiveness of healthcare interventions and treatments. It combines the length of life with the quality of life by assigning a utility or preference score to different health states, where 1 represents perfect health and 0 represents death, and values between 0 and 1 represent varying degrees of health-related quality of life.
• used at a national level
• we want to maximise it

Question 11

what is a DALY?

Answer 11

Disability-adjusted Life Year
A comprehensive measure that quantifies the burden of disease and disability at the population level. It combines the years of life lost (YLL) due to premature mortality with the years lived with disability (YLD) to estimate the

Question 12

how do you calculate a DALY?

Answer 12

DALYs are calculated by adding YLL and YLD, where YLL accounts for the years of life lost before the expected life span, and YLD accounts for the years lived with a health condition while adjusting for its severity.

Inverted Scoring: Full health is represented by a score of 0 while death is represented by 1. Scores in-between represent various disability weights.

Question 13

how do you calculate a QALY?

Answer 13

QALYs are calculated by multiplying the time spent in a particular health state by the utility score associated with that state. For example, a year in perfect health is assigned a utility of 1, whereas a year in a health state with reduced quality of life may have a utility value less than 1.

Question 14

what is a disability?

Answer 14

the loss of ability to carry out an activity that is considered normal for human beings, as a result of impairment (DALY)

Question 15

how do you calculate cost-effectiveness?

Answer 15

CEA ratio = [unit of cost] / [QALYs]

Given the fixed amount of resource, health intervention A is more cost-effective than B if and only if A produces more QALYs than B.

Question 16

What is cost-effective analysis?

Answer 16

A method used in health economics and healthcare decision-making to assess and compare the costs and outcomes of different healthcare interventions, treatments, programs, or policies. Its primary objective is to determine whether an intervention provides value for money by comparing the incremental costs (the additional costs associated with the intervention) to the incremental outcomes (the additional health benefits or outcomes achieved).

Question 17

what is the incremental cost-effectiveness ration, and how do you calculate it?

Answer 17

A key measure used in cost-effectiveness analysis (CEA) to assess and compare the efficiency of different healthcare interventions, treatments, programs, or policies. Specifically, the ICER quantifies the additional cost required to achieve an additional unit of health outcome or effectiveness when comparing one intervention to an alternative or “do-nothing” scenario.

ICER = (Cost of Intervention A - Cost of Intervention B) / (Outcome of Intervention A - Outcome of Intervention B)

Question 18

summarise the 1990 Oregon Health plan, and how it was innovative

Answer 18

state-level healthcare reform initiative proposed in the U.S. state of Oregon. It aimed to expand access to healthcare services for low-income individuals and families, especially those without health insurance. The plan was innovative in its approach to prioritizing and allocating healthcare resources based on a system of “prioritization of services” and was among the early attempts at healthcare rationing in the United States. Critics argued that it could result in ableism, with individuals being denied certain treatments or services deemed less cost-effective.

Question 19

what is the goal of the disease control priorities project?

Answer 19

A global initiative that aims to provide policymakers and healthcare leaders with evidence-based information and recommendations for improving healthcare delivery, particularly in low- and middle-income countries. The project focuses on addressing the burden of diseases, reducing health inequalities, and maximizing the impact of healthcare resources in resource-constrained settings.

Question 20

what is total utilitarianism?

Answer 20

A consequentialist ethical theory that evaluates the moral rightness or wrongness of actions based on the total overall utility or happiness they produce in society.

Question 21

what are Prioritarianism?

Answer 21

An ethical theory that emphasizes the importance of benefiting the worse-off individuals in society. It is a consequentialist moral theory, meaning that it evaluates the morality of actions, policies, or distributions of goods and resources based on the outcomes they produce.

Question 22

what is discounting?

Answer 22

the practice of adjusting the value of future health outcomes or life years gained to reflect their present or current value. Discounting is used in health economics and cost-effectiveness analysis to account for the time preference for health benefits and costs.

Question 23

When are equity weights used?

Answer 23

Equity weights in Quality-Adjusted Life Years (QALYs) are an approach used to incorporate considerations of equity and fairness into the calculation and interpretation of QALYs in health economics and healthcare decision-making.

Question 24

what is Hausman’s key argument in “the value of health”?

Answer 24

health is a prerequisite for many other values and capabilities. Hausman discusses how good health allows individuals to pursue a range of activities and goals, making it a foundational aspect of a well-lived life.

Question 25

what does hausman argue about wellbeing and health?

Answer 25

Hausman explores the relationship between health and overall well-being. He argues that while health is a significant component of well-being, it is not the only component. Other factors, such as relationships, personal achievements, and happiness, also play crucial roles.