HTA - lecture 4 - quality of life (A)

Question 1

EE definition

Answer 1

the comparative analysis of alternative courses of action in terms of both their costs and consequences.

Question 2

what is health: 2 definitions

Answer 2

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” (WHO, 1948)

“Health is the ability to adapt and to self manage, in the face of social, physical and emotional challenges” (Huber et al., 2011 BMJ 343)

Question 3

health outcomes and EEs

Answer 3

Aim of EEs: facilitate health care decision making
Reimbursement decision:
* For fixed health care budget
* For different treatment
* For different diseases

We prefer a broad measure of health

Question 4

QALYs

Answer 4

combining mortality and morbidity outcomes

mortality = saving/ prolonging life

morbidity = improving the quality of life

Question 5

QALY calculation

Answer 5

QALY = V(Q) * Y

V(Q) = the value function of quality measured on a scale between 0 (death) and 1 (full/ perfect health)
Y = life years spent with the corresponding V(Q)

Question 6

How can two diseases be compared with one another?

Answer 6

Measure the subjective value attached to a health state
Move beyond multidimensionality of health by measuring an overarching concept

Question 7

direct valuation

Answer 7

Ask patients to value their own health

How to value?
* Visual-analogue scale (VAS)
* Time trade-off (TTO)
* Standard gamble (SG)

three different ways to calculate V(Q)

Question 8

VAS

Answer 8

question: how is your quality of life?

Question 9

TTO

Answer 9

Question: “How many life years in perfect health would you trade-off for a cure?”

Question 10

SG

Answer 10

Question: What risk of dying would you accept for a cure?

Question 11

indirect valuation

Answer 11

ask other people to value the described health condition

Question 12

EQ-5D

Answer 12

5 domains: mobility, self-care, usual activities, paitn/discomfort and anxiety/depression  generic questions

Question 13

developing a valuation algorithm

Answer 13

1. measure value of some health status
2. estimate value of other health states

Question 14

generic questionnaires

Answer 14

§ Measures any disease
§ Less specific questions
Examples:
* EQ-5D
* SF-6D
* Health utilities index (HUI)

Question 15

Disease-specific questionnaires

Answer 15

§ Limited applicability
§ More specific questions
Examples:
* EORTC QLQ-C30
* St. George respiratory questionnaire