Equal Value of Life Years Gained

Last updated

The Equal Value of Life Years Gained or evLYG is a generic measure used to determine how much a medical treatment can extend the life of the patient. Unlike other healthcare metrics, the evLYG does not consider the quality of life for the patient; it exclusively considers the length of life. It is used in economic evaluation to determine the added time a treatment may give a patient. [1] Critics argue the evLYG measurement is flawed because it values a medication based solely on the added years of life. A higher priced drug that both extends life and adds two years of life receives the same evLYG score as a lower priced drug that adds two years but does not improve life. [2]

The evLYG is used in concert with the Quality-Adjusted Life Year (QALY) to reduce the discriminatory characteristics of the QALY, which has been criticized as being ageist or ableist for placing more value on the lives of younger people without disability. [3] The Institute for Clinical and Economic Review (ICER) uses a hybrid of the QALY and the evLYG to determine treatment prices. [4] [5] Critics have argued the use of the evLYG along with the QALY does not do enough to fully eliminate the discriminatory aspects of the QALY measurement. [6]

Related Research Articles

The value of life is an economic value used to quantify the benefit of avoiding a fatality. It is also referred to as the cost of life, value of preventing a fatality (VPF), implied cost of averting a fatality (ICAF), and value of a statistical life (VSL). In social and political sciences, it is the marginal cost of death prevention in a certain class of circumstances. In many studies the value also includes the quality of life, the expected life time remaining, as well as the earning potential of a given person especially for an after-the-fact payment in a wrongful death claim lawsuit.

Cost-effectiveness analysis (CEA) is a form of economic analysis that compares the relative costs and outcomes (effects) of different courses of action. Cost-effectiveness analysis is distinct from cost–benefit analysis, which assigns a monetary value to the measure of effect. Cost-effectiveness analysis is often used in the field of health services, where it may be inappropriate to monetize health effect. Typically the CEA is expressed in terms of a ratio where the denominator is a gain in health from a measure and the numerator is the cost associated with the health gain. The most commonly used outcome measure is quality-adjusted life years (QALY).

The incremental cost-effectiveness ratio (ICER) is a statistic used in cost-effectiveness analysis to summarise the cost-effectiveness of a health care intervention. It is defined by the difference in cost between two possible interventions, divided by the difference in their effect. It represents the average incremental cost associated with 1 additional unit of the measure of effect. The ICER can be estimated as:

Health economics Branch of economics

Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. Health economics is important in determining how to improve health outcomes and lifestyle patterns through interactions between individuals, healthcare providers and clinical settings. In broad terms, health economists study the functioning of healthcare systems and health-affecting behaviors such as smoking, diabetes, and obesity.

Prescription drug list prices in the United States continually rank among the highest in the world. The high cost of prescription drugs became a major topic of discussion in the 21st century, leading up to the U.S. health care reform debate of 2009, and received renewed attention in 2015. One major reason for high prescription drug prices in the United States relative to other countries is the inability of government-granted monopolies in the U.S. health care sector to use their bargaining power to negotiate lower prices and that the US payer ends up subsidizing the world's R&D spending on drugs. The Democratic Party is broadly in favor of allowing the government to negotiate drug prices, whereas the Republican Party has prevented passage of bills that would permit that.

An orphan drug is a pharmaceutical agent developed to treat medical conditions which, because they are so rare, would not be profitable to produce without government assistance. The conditions are referred to as orphan diseases.

National Institute for Health and Care Excellence Non-departmental public body of the Department of Health in the United Kingdom

The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health and Social Care in England that publishes guidelines in four areas:

Preventive healthcare Prevent and minimize the occurrence of diseases

Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention. Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices, and are dynamic processes which begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention.

Cost–utility analysis (CUA) is a form of financial analysis used to guide procurement decisions.

Quality-adjusted life year Measure of disease burden

The quality-adjusted life year or quality-adjusted life year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value of medical interventions. One QALY equates to one year in perfect health. QALY scores range from 1 to 0 (dead). QALYs can be used to inform health insurance coverage determinations, treatment decisions, to evaluate programs, and to set priorities for future programs.

Disability-adjusted life year Measure of disease burden

The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. It was developed in the 1990s as a way of comparing the overall health and life expectancy of different countries.

Pharmacoeconomics refers to the scientific discipline that compares the value of one pharmaceutical drug or drug therapy to another. It is a sub-discipline of health economics. A pharmacoeconomic study evaluates the cost and effects of a pharmaceutical product. Pharmacoeconomic studies serve to guide optimal healthcare resource allocation, in a standardized and scientifically grounded manner.

Eculizumab Pharmaceutical drug

Eculizumab, sold under the brand name Soliris among others, is a medication used to treat paroxysmal nocturnal hemoglobinuria (PNH), atypical hemolytic uremic syndrome (aHUS), generalized myasthenia gravis, and neuromyelitis optica. In people with PNH, it reduces both the destruction of red blood cells and need for blood transfusion, but does not appear to affect the risk of death. Eculizumab was the first drug approved for each of its uses, and its approval was granted based on small trials. It is given in a clinic by intravenous (IV) infusion.

In medicine, an indication is a valid reason to use a certain test, medication, procedure, or surgery. There can be multiple indications to use a procedure or medication. An indication can commonly be confused with the term diagnosis. A diagnosis is the assessment that a particular [medical] condition is present while an indication is a reason for use. The opposite of an indication is a contraindication, a reason to withhold a certain medical treatment because the risks of treatment clearly outweigh the benefits.

Comparative effectiveness research (CER) is the direct comparison of existing health care interventions to determine which work best for which patients and which pose the greatest benefits and harms. The core question of comparative effectiveness research is which treatment works best, for whom, and under what circumstances. Engaging various stakeholders in this process, while difficult, makes research more applicable through providing information that improves patient decision making.

Healthcare rationing in the United States exists in various forms. Access to private health insurance is rationed on price and ability to pay. Those unable to afford a health insurance policy are unable to acquire a private plan except by employer-provided and other job-attached coverage, and insurance companies sometimes pre-screen applicants for pre-existing medical conditions. Applicants with such conditions may be declined cover or pay higher premiums and/or have extra conditions imposed such as a waiting period.

The Cancer Drugs Fund (CDF) was introduced in England in 2011. It was established in order to provide a means by which National Health Service (NHS) patients in England could get cancer drugs rejected by National Institute for Health and Care Excellence because they were not cost effective. Its establishment was confirmed by the UK government's coalition agreement in 2010, and by the White Paper, Equity and excellence – Liberating the NHS.

Arnold VenturesLLC is focused on evidence-based giving in a wide range of categories including: criminal justice, education, health care, and public finance. The organization was founded by billionaires John D. Arnold and Laura Arnold in 2010.

The Institute for Clinical and Economic Review (ICER) is a Boston-based independent nonprofit organization that seeks to place a value on medical care by providing comprehensive clinical and cost-effectiveness analyses of treatments, tests, and procedures.

ISPOR—The Professional Society for Health Economics and Outcomes Research, better known as ISPOR, is a nonprofit global professional organization in health economics and outcomes research. It was founded in 1995 as an international multidisciplinary professional organization that advances the policy, science, and practice of pharmacoeconomics and outcomes research. The society's mission is to promote health economics and outcomes research to improve decision making for health globally.

References

  1. "ICER to use new metric to assess drug cost-effectiveness". The Pharma Letter . Retrieved 20 July 2021.
  2. Cohen, Joshua; Ollendorf, Daniel; Neumann, Peter. "Will ICER's Response to Attacks on the QALY Quiet the Critics?". Center for the Evaluation of Value and Risks in Health. Retrieved 20 July 2021.
  3. Carlson, Josh; Brouwer, Elizabeth; Kim, Eunice; Wright, Phoebe; McQueen, Brett. "Alternative Approaches to Quality-Adjusted Life-Year Estimation Within Standard Cost-Effectiveness Models: Literature Review, Feasibility Assessment, and Impact Evaluation". Science Direct . Retrieved 20 July 2021.
  4. Cohen, Joshua. "A QALY Is A QALY Is A QALY, Or Is It?". Forbes . Retrieved 20 July 2021.
  5. "Cost-Effectiveness, the QALY, and the evLYG". ICER. Retrieved 20 July 2021.
  6. "An Introduction to the Institute for Clinical and Economic Review (ICER) and Their Implications for New Sickle Cell Disease Treatments: A Primer on the Issues" (PDF). Sickle Cell Consortium. Retrieved 20 July 2021.