Intro QALY & need assessment
Download
Report
Transcript Intro QALY & need assessment
Patient values or
values from the general public
1
The clinical perspective
Quality
of life is subjective…..
“Given its inherently subjective nature, consensus was quickly
reached that quality of life ratings should, whenever possible,
be elicited directly from patients themselves. “
• (Neil Aaronson, in B. Spilker: Quality of life and
Pharmacoeconomics in Clinical Trails, 1996, page 180)
…therefore
ask the patient!
2
A problem in the patient perspective….
Stensman
Healthy
Scan J Rehab Med
1985;17:87-99.
Scores
on a visual
analogue scale
36 subjects in a
wheelchair
36 normal matched
controls
Mean
score
Wheelchair: 8.0
Health controls: 8.3
Death
3
The economic perspective
In
a normal market: the consumer values count
The patient seems to be the consumer
Thus the values of the patients….
If
indeed health care is a normal market…
But is it….?
4
Health care is not a normal market
Supply
induced demands
Government control
Financial support (egalitarian structure)
Patient Consumer
The patient does not pay
Consumer
= General public
Potential patients are paying
Health
care is an insurance market
A compulsory insurance market
5
Health care is an insurance market
Values
of benefit in health care have to be
judged from a insurance perspective
Who values should be used the insurance
perspective?
6
Who determines the payments
of unemployment insurance?
Civil
servant
Knowledge: professional
But suspected for strategical answers
• more money, less problems
• identify with unemployed persons
The
unemployed persons themselves
Knowledge: specific
But suspected for strategical answers
General
public (politicians)
Knowledge: experience
Payers
7
Who’s values (of quality of life) should
count in the health insurance?
Doctors
Knowledge: professional
But suspected for strategical answers
• See only selection of patient
• Identification with own patient
Patients
General public
Knowledge: disease specific
But suspected for strategical answers
But coping
Knowledge: experience
Payers
Like costs: the societal perspective
8
The general public should be
informed…
Valuing
without knowledge makes no sense
Thyroid Eye Disease
Give
description of the disease
A patient with bilateral thyroid
eye disease with upper lid
retraction and exophthalmos.
9
…or use validated questionnaires
MOBILITY
I have no problems in walking about
I have some problems in walking about
I am confined to bed
SELF-CARE
I have no problems with self-care
I have some problems washing or dressing myself
I am unable to wash or dress myself
USUAL ACTIVITIES (e.g. work, study, housework family or
leisure activities)
I have no problems with performing my usual activities
I have some problems with performing my usual activities
I am unable to perform my usual activities
PAIN/DISCOMFORT
I have no pain or discomfort
I have moderate pain or discomfort
I have extreme pain or discomfort
ANXIETY/DEPRESSION
I am not anxious or depressed
I am moderately anxious or depressed
I am extremely anxious or depressed
10
Validated Questionnaires
Describe
health states
Have values from the general public
Rosser Matrix
QWB
15D
HUI Mark 2
HUI Mark 3
EuroQol EQ-5D
11
Different perspective belong to
different research questions
Health
economics
Societal perspective
• General public
Medical
decision making
Patients perspective
Epidemiology
Doctors perspective
• Global Burden of Disease
12