HTA - lecture 9 - beyond QALY

Question 1

advantage QALY

Answer 1

• Generic measure that combines length of life with quality of life and allows comparison across different diseases and interventions

Question 2

important outcomes of long term care

Answer 2

• Providing support with ageing in place
• Maintaining autonomy
• Involvement in decision making
• Having one’s dignity respected
• Living xaa fulfilling life, making life meaningful
• Providing security, safety
• Satisfaction with care process (attitudes of staff, continuity of care, person-centredness)

Question 3

wellbeing instruments: adults

Answer 3

capability: ICECAP-A
functioning: WiX, ASCOT, EQ-HWB

Question 4

wellbeing instruments: elderly

Answer 4

capability: ICECAP-O
functioning: WOOP

Question 5

wellbeing instruments: last phase of life

Answer 5

capability: ICEPCAP-SCM

Question 6

concerns about including additional value elements

Answer 6

• Elements are dissimilar in terms of their target group
  o Fear of contagion and insurance value are benefits for general public
  o Value of knowing, value of hope, real option value are benefits for patients
  o Severity of disease, equity, and scientific spillovers are related to societal goalsetting
• Unclear how to measure many of the identified additional elements of value
• Risk of double counting (within the set of elements (equity and severity and between elements and QALY (reduction in uncertainty is included in QALY))
• Disproportional attention to elements of ‘positive value’ compared to elements of ‘negative value’ of harm.
• Real option value to life-extending treatments implicitly prioritizes length of length over quality of life, in return for a chance that relevant advances in medicine happen in the additional life time
• Our willingness to pay for and/or willingness to trade-off length and/ or quality of life for these additional elements of value is unknown
• If we would include additional elements of value, we may adopt interventions that generate these additional elements at the expense of interventions improving length and quality of life

Question 7

steps in multi-criteria decision analyses (MCDA)

Answer 7

1. Decision context
2. Selection of MCDA technique
3. Definition of criteria (outcomes)
4. Criteria weights
5. Performance scores
6. Calculation of total scores
7. Uncertainty analysis
8. Presentation (deliberative process)