3.3.2 Quality Adjusted Life Years (QALYs)

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来自 University of Minnesota 的课程

Medical Technology and Evaluation

105 个评分

University of Minnesota

Medical Technology and Evaluation

105 个评分

课程 4（共 5 门，Specialization 医疗市场）

Innovations in medical technologies are one of the leading areas of economic growth in the world. Whether new technologies take the form of pharmaceutical, medical device, biotechnology, information technology of some combination of these innovations, the opportunities for both private enterprise and social welfare are substantial. However, these innovations are not without cost, and require reimbursement from either a privately or publicly financed health care delivery system to enter the marketplace. This course aims to provide knowledge of the concepts, data, and methodology required to critically evaluate new medical technologies in order to secure financial investment, reimbursement, and regulatory compliance objectives, such as FDA approval. The course is designed to provide understanding of the analytic tools needed to evaluate medical technologies. After completing this course, students will have the skills needed to: - Understand the reimbursement systems financing medical technology use. - Understand the role of government and regulatory agencies in the development and use of new medical technologies. - Identify a population to be served by a medical technology. - Use health care data to evaluate a medical technology. - Perform cost/benefit and cost/effectiveness analysis of a new technology.

从本节课中

The Elements of Medical Technology Assessments

In this module we will discuss a variety of types of medical technology evaluation approaches and the types of assessments. We will go into detail about the pros and cons of each type of assessment as a way to illustrate situations where one approach may be better than another. Finally, we will also cover the details of the two fundamental features of any evaluation: measuring costs and benefits.

3.3.1 Benefits6:35

3.3.2 Quality Adjusted Life Years (QALYs)5:53

3.3.3 Measuring Quality of Life (QoL)5:11

与讲师见面

Eric Barrette
Director of Research
Health Care Cost Institute

This is lesson 3.3.2, Quality Adjusted Life Years.

In this lesson we focus on deriving and calculating the quality

adjusted life year, which can be used to measure the benefits of a technology.

The quality adjusted life year, or

QALY, combines morbidity and mortality into a single measure.

Mortality is measured in terms of the life years or expected life years gained.

Morbidity is measured

by the quality of life that's associated with those extra years of life.

The quality of life dimensions are weighted according to an individuals

preferences measured in units often referred to as utility.

A quality of life weight ranges between zero and one.

Where zero is the quality of life associated with death, and

one Is associated with perfect health.

The quality is simply the calculation of the quality of life measure,

times the number of years in a particular house state.

And then the total benefit is the some of all qualities over time.

This can be represented graphically which I'll show on the following slide.

Consider the example of an 82 year old male

who has a heart attack at the age of 85.

At the age of 82, this individual has a quality

of life of 0.95, that's close too but not perfect health.

That health remains for the next three years,

however at the age of 85 this person has a heart attack and then for

the following two years, they have a quality of life of 0.75.

Then, unfortunately, at the age of 87, this person passes away.

Now, we can calculate the qualities associated with the treatment for

a heart attack by calculating the sum that was described on the first slide.

3 years at 0.95 quality of life

units + 2 years X 0.75 quality

of life units = 4.35 total QALYs.

Now we can assess how a new treatment for a heart attack either increases or

decreases the total QALYs available to this person.

Assume that the new treatment is offered to this person

in year three when they have their heart attack.

So again, this person starts at age 82 with 0.95 quality of life units.

Then at age 85 this person has a heart attack, but instead of

receiving the standard treatment they receive the new treatment and

therefore they don't end at 0.75 quality of life units like they did before.

Rather the treatment provides them with 0.85 quality of life units,

and results in a longer amount of expected life years,

and they end up living for a total of Four more years, out to here.

So now we can calculate the total QALYs as 3 times 0.95,

which is the same as before, but now, following the heart attack,

it's four years times 0.85 ,85 units

which is equal to 6.25 QALY's.

The benefits of the new treatment for

heart attack can then be calculated as the difference between the total QALY's for

the new treatment minus.

The total QALYs for the old treatment.

The difference is 1.9 QALYs.

In other words the new heart attack treatment results in

an increase in 1.9 Quality Adjusted Life Years.

There are a few more things to remember when using or calculating QALYs.

First, it is important to remember that death has a quality of life

rate of 0 in order to be able to combine morbidity and mortality.

Now there are some who would argue that

living with some diseases is worse than death.

In this case, the quality of life weight would have a negative value and

this complicates the calculations of QALYs.

Second, the quality of life scale must have an interval property.

This means that increase in quality of life from 0.3 to 0.4 but

difference of One unit, or zero point one units,

has the same meaning in terms of quality of life improvement as the difference

between 0.7 to 0.8 also a difference

of 0.1 units Now this may or

may not be a strong assumption, depending on the technology that's being assessed.

However, in order for the QALYs to be calculated in the way we described,

this assumption must be made.

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