354:, and constant proportional tradeoff behavior. For the more general case of a life time health profile (i.e., experiencing more than one health state during the remaining years of life), the utility of a life time health profile must equal the sum of single-period utilities. Because of these theoretical assumptions, the meaning and usefulness of the QALY is debated. Perfect health is difficult, if not impossible, to define. Some argue that there are health states worse than being dead, and that therefore there should be negative values possible on the health spectrum (indeed, some health economists have incorporated negative values into calculations). Determining the level of health depends on measures that some argue place disproportionate importance on physical pain or disability over mental health.
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quality of life—into a single number that can be compared across different types of treatments. For example, one year lived in perfect health equates to 1 QALY. This can be interpreted as a person getting 100% of the value for that year. A year lived in a less than perfect state of health can also be expressed as the amount of value accrued to the person living it. For example, 1 year of life lived in a situation with utility 0.5 yields 0.5 QALYs—a person experiencing this state is getting only 50% of the possible value of that year. In other words, they value the experience of being in less than perfect health for a full year as much as they value living for half a year in perfect health (0.5 years × 1 Utility).
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385:, the study's lead author, was quoted as saying that it was the "largest-ever study specifically dedicated to testing the assumptions of the QALY." In January 2013, at its final conference, ECHOUTCOME released preliminary results of its study which surveyed 1361 people "from academia" in Belgium, France, Italy and the UK. The researchers asked the subjects to respond to 14 questions concerning their preferences for various health states and durations of those states (e.g., 15 years limping versus 5 years in a wheelchair). They concluded that:
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not take into account equity issues such as the overall distribution of health states—particularly since younger, healthier cohorts have many times more QALYs than older or sicker individuals. As a result, QALY analysis may undervalue treatments which benefit the elderly or others with a lower life expectancy. Also, many would argue that all else being equal, patients with more severe illness should be prioritized over patients with less severe illness if both would get the same absolute increase in utility.
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innovation had stalled since NICE was founded. At the time, one in seven drugs were turned down. Additionally there is a trend where QALY is getting position as a capital allocation tool although many sources and publications show that QALY has relatively significant gaps as formula and as organization management mechanism in healthcare
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and immoral or "inhuman acting" are frequently used arguments to ignore cost-effectiveness analysis and the use of QALYs. Especially during the 2020/2021 Covid-19 pandemic, national responses represented a massive form of applying the 'rule of rescue' and disregard of cost-effectiveness analysis (see
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value (or utility weight) associated with a given state of health by the years lived in that state. The underlying measure of utility is derived from clinical trials, and studies that measure how people feel in these specific states of health. The way they feel in a state of perfect health equates to
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Demonstration of quality-adjusted life years (QALYs) for two individuals. Individual A (who did not receive an intervention) has fewer QALYs than individual B (who received an intervention). The letters A and B designate the boundary lines, with the QALY for A being only the blue area, the QALY for B
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calculus to determine who will or will not receive treatment. However, its supporters argue that since health care resources are inevitably limited, this method enables them to be allocated in the way that is approximately optimal for society, including most patients. Another concern is that it does
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The QALY calculation is simple: the change in utility value induced by the treatment is multiplied by the duration of the treatment effect to provide the number of QALYs gained. QALYs can then be incorporated with medical costs to arrive at a final common denominator of cost/QALY. This parameter can
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A measure of the state of health of a person or group in which the benefits, in terms of length of life, are adjusted to reflect the quality of life. One quality-adjusted life year (QALY) is equal to 1 year of life in perfect health. It combines two different benefits of treatment—length of life and
56:
Critics argue that the QALY oversimplifies how actual patients would assess risks and outcomes, and that its use may restrict patients with disabilities from accessing treatment. Proponents of the measure acknowledge that the QALY has some shortcomings, but that its ability to quantify tradeoffs and
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theory: if a set of conditions pertaining to agent preferences on life years and quality of life are verified, then it is possible to express the agent's preferences about couples (number of life years/health state), by an interval (Neumannian) utility function. This utility function would be equal
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The first mention of
Quality Adjusted Life Years appeared in a doctoral thesis at Harvard University by Joseph S. Pliskin (1974). The need to consider quality of life is credited to work by Klarman et al. (1968), Fanshel and Bush (1970) and Torrance et al. (1972) who suggested the idea of length of
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Critics also argue that a QALY-based system would limit research on treatments for rare disorders because the upfront costs of the treatments tend to be higher. Officials in the United
Kingdom were forced to create the Cancer Drugs Fund to pay for new drugs regardless of their QALY rating because
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The
Partnership to Improve Patient Care, a group opposed to the adoption of QALY-based metrics, argued that a QALY-based system could exacerbate racial disparities in medicine because there is no consideration of genetic background, demographics, or comorbidities that may be elevated in minority
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Beresniak, Ariel; Medina-Lara, Antonieta; Auray, Jean Paul; De Wever, Alain; Praet, Jean-Claude; Tarricone, Rosanna; Torbica, Aleksandra; Dupont, Danielle; Lamure, Michel; Duru, Gerard (2015). "Validation of the
Underlying Assumptions of the Quality-Adjusted Life-Years Outcome: Results from the
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Both the Rule of rescue and immoral behavior are heavily attacked by
Shepley Orr and Jonathan Wolff in their 2014 article "Reconciling cost-effectiveness with the rule of rescue: the institutional division of moral labor". They argued that the "Rule of rescue" is the result of wrong reasoning.
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and others are exploring improvements to or replacements for QALYs. Among other possibilities are extending the data used to calculate QALYs (e.g., by using different survey instruments); "using well-being to value outcomes" (e.g., by developing a "well-being-adjusted life-year"; and by value
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a value of 1 (or 100%). Death is assigned a utility of 0 (or 0%), and in some circumstances it is possible to accrue negative QALYs to reflect health states deemed "worse than dead." The value people perceive in less than perfect states of health are expressed as a fraction between 0 and 1.
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ECHOUTCOME also released "European
Guidelines for Cost-Effectiveness Assessments of Health Technologies", which recommended not using QALYs in healthcare decision making. Instead, the guidelines recommended that cost-effectiveness analyses focus on "costs per relevant clinical outcome."
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The use of QALYs has been criticized by disability advocates because otherwise healthy individuals cannot return to full health or achieve a high QALY score. Treatments for quadriplegics, patients with multiple sclerosis, or other disabilities are valued less under a QALY-based system.
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interventions. One QALY equates to one year in perfect health. QALY scores range from 1 (perfect health) 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.
182:(VAS): Respondents are asked to rate a state of ill health on a scale from 0 to 100, with 0 representing being dead, and 100 representing perfect health. This method has the advantage of being the easiest to ask, but is the most subjective.
245:, the Secretary of Health and Human Services at the time, criticized the plan by stating that "Oregon's plan in substantial part values the life of a person with a disability less than the life of a person without a disability."
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Standard gamble (SG): Respondents are asked to choose between remaining in a state of ill health for a period of time, or choosing a medical intervention which has a chance of either restoring them to perfect health or killing
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Critics have also noted that QALY only considers the quality of life when patients may choose to suffer negative side-effects to live long enough to attend a milestone event, such as a wedding or graduation.
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questionnaire, which categorizes health states according to five dimensions: mobility, self-care, usual activities (e.g. work, study, homework or leisure activities), pain/discomfort and anxiety/depression.
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While supporters laud QALY's efficiency, critics argue that use of QALY can cause medical inefficiencies because a less-effective, cheaper drug may be approved based on its QALY calculation.
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Fifth, the UK's
National Institute for Health and Care Excellence uses QALYs that are based on 3395 interviews with residents of the UK, as opposed to residents of several European countries.
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Cost-effectiveness reasoning with the aid of QALYs always leads to moral superior outcomes and optimal public health outcome, although not always perfect, given constraints of resources.
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The utility values used in QALY calculations are generally determined by methods that measure people's willingness to trade time in different health states, such as those proposed in the
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Finally, according to Franco Sassi, a senior health economist at the
Organization for Economic Co-operation and Development, people who call for the elimination of QALYs may have "
1943:
1442:
Mortimer, D.; Segal, L. (2007). "Comparing the
Incomparable? A Systematic Review of Competing Techniques for Converting Descriptive Measures of Health Status into QALY-Weights".
172:(TTO): Respondents are asked to choose between remaining in a state of ill health for a period of time, or being restored to perfect health but having a shorter life expectancy.
1614:
Nord, Erik; Pinto, Jose Luis; Richardson, Jeff; Menzel, Paul; Ubel, Peter (1999). "Incorporating societal concerns for fairness in numerical valuations of health programmes".
1521:
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Klarman, Herbert E.; Francis, John O'S; Rosenthal, Gerald D. (1968). "Cost effectiveness analysis applied to the treatment of chronic renal disease".
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Another way of determining the weight associated with a particular health state is to use standard descriptive systems such as the EuroQol Group's
2016:
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attempted to reform its
Medicaid system by incorporating the QALY metric. This was found to be discriminatory, and in violation of the
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of 1.5% for QALYs, which is lower than the discount rates for other costs and benefits, because the QALY is a direct utility measure.
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The second input is the amount of time people live in various states of health. This information usually comes from clinical trials.
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377:, the European Consortium in Healthcare Outcomes and Cost-Benefit Research (ECHOUTCOME) began a major study on QALYs as used in
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Mehrez, A; Gafni, A (April 1991). "The healthy-years equivalents: how to measure them using the standard gamble approach".
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and McKenzie recommended that research be conducted concerning the validity of QALYs. In 2010, with funding from the
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to the product of an interval utility function on "life years", and an interval utility function on "health state".
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In response to the ECHOUTCOME study, representatives of the National Institute for Health and Care Excellence, the
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to estimate the cost-per-QALY associated with a health care intervention. This parameter can be used to develop a
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Pliskin, J. S.; Shepard, D. S.; Weinstein, M. C. (1980). "Utility Functions for Life Years and Health Status".
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100:
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EuroQol Group (1990-12-01). "EuroQol--a new facility for the measurement of health-related quality of life".
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racial groups that do not have as much weight in the consideration of the average year of perfect health.
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Valuing health care: Costs, benefits, and effectiveness of pharmaceuticals and other medical technologies
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from the patient, and societal perspective make it a critical tool for equitably allocating resources.
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Torrance, George E. (1986). "Measurement of health state utilities for economic appraisal: A review".
2922:
2701:
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2488:
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389:"Preferences expressed by the respondents were not consistent with the QALY theoretical assumptions";
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and Shepard was the first appearance in print of the term. QALYs were later promoted through medical
2043:"Reconciling cost-effectiveness with the rule of rescue: the institutional division of moral labour"
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Gandjour, A; Gafni, A (March 2010). "The additive utility assumption of the QALY model revisited".
85:
1994:
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Weinstein, Milton; Zeckhauser, Richard (1973-04-01). "Critical ratios and efficient allocation".
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Loomes, Graham; McKenzie, Lynda (1989). "The use of QALYs in health care decision making".
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1944:"Key Questions for Legislators on the Institute for Clinical and Economic Review (ICER)"
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988:"Perspective | The eugenic roots of 'quality adjusted life years,' and why they matter"
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The method of ranking interventions on grounds of their cost per QALY gained ratio (or
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in health-related quality of life with age, for example through healthier life choices.
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being the blue area plus the additional tan area. NB It is possible to experience an
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European Consortium in Healthcare Outcomes and Cost-Benefit Research (ECHOUTCOME).
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1701:"ECHOUTCOME: European Consortium in Healthcare Outcomes and Cost-Benefit Research"
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1868:"European Guidelines for Cost-Effectiveness Assessments of Health Technologies"
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Fourth, the researchers did not take budgetary constraints into consideration.
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1386:"Problems and solutions in calculating quality-adjusted life years (QALYs)"
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782:"Problems and solutions in calculating quality-adjusted life years (QALYs)"
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723:"Problems and solutions in calculating quality-adjusted life years (QALYs)"
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44:, including both the quality and the quantity of life lived. It is used in
2087:"Improving Cross-Sector Comparisons: Going Beyond the Health-Related QALY"
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230:, used "ÂŁ per QALY" to evaluate their utility since its founding in 1999.
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1590:, Institute for Innovation & Valuation in Health Care, archived from
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362:
263:
212:
1894:
Krell, J; Kirkdale, R; O'Hanlon Brown, C; Tuthill, M; Waxman, J (2010).
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10.1002/(SICI)1099-1050(199902)8:1<25::AID-HEC398>3.0.CO;2-H
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1091:"A health-status index and its application to health-services outcomes"
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life adjusted by indices of functionality or health. A 1976 article by
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2017:"Obscure Model Puts a Price on Good Health—and Drives Down Drug Costs"
1970:"The U.S. shouldn't use the 'QALY' in drug cost-effectiveness reviews"
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1131:"A utility maximization model for evaluation of health care programs"
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592:"Judging whether public health interventions offer value for money"
226:(NICE), which advises on the use of health technologies within the
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Weinstein, Milton C.; Torrance, George; McGuire, Alistair (2009).
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1733:"Report triggers quibbles over QALYs, a staple of health metrics"
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19:
1180:"Utility assessment for estimating quality-adjusted life years"
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Need to fix citation format of new additions and notify author.
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Therefore, calculating a QALY requires two inputs. One is the
1522:"Developing methods that really do value the 'Q' in the QALY"
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Willingness to gain or lose life-years is constant over time.
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Life-years and quality of life are independent of each other;
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2840:
List of international healthcare accreditation organizations
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Third, problems with QALYs were already widely acknowledged.
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In 1980, Pliskin et al. justified the QALY indicator using
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be used to compare the cost-effectiveness of any treatment
1613:
1256:"Calculating QALYs, comparing QALY and DALY calculations"
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Measures of efficiency in healthcare: QALMs about QALYs?
1022:"Opinion | Oregon Health Plan Is Unfair to the Disabled"
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Quality of life can be measured in consistent intervals;
1995:"Do you use the QALY metric? Be careful. - RemedyBytes"
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Data on medical costs are often combined with QALYs in
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Organisation for Economic Co-operation and Development
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Existential risk from artificial general intelligence
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According to Pliskin et al., the QALY model requires
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All-Party Parliamentary Group for Future Generations
1856:
1783:"Researchers claim NHS drug decisions 'are flawed'"
1129:Torrance, G W; Thomas, W.H.; Sackett, D.L. (1972).
936:Appleby, J.; Devlin, N.; Parkin, D. (August 2007).
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908:
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986:
421:First, QALYs are better than alternative measures.
1206:
624:National Institute for Health and Care Excellence
596:National Institute for Health and Care Excellence
224:National Institute for Health and Care Excellence
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721:Prieto, Luis; Sacristán, José A. (2003-12-19).
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2389:Centre for Enabling EA Learning & Research
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361:) is controversial because it implies a quasi-
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2678:Superintelligence: Paths, Dangers, Strategies
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1207:Zeckhauser, Richard; Shepard, Donald (1976).
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215:resources, often using a threshold approach.
2252:Psychological barriers to effective altruism
2041:Orr, Shepley; Wolff, Jonathan (2015-04-01).
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103:. Unsourced material may be challenged and
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780:Prieto, Luis; Sacristán, José A. (2003).
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334:Learn how and when to remove this message
123:Learn how and when to remove this message
2399:Centre for the Study of Existential Risk
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1384:Prieto, Luis; Sacristán, José A (2003).
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2479:Machine Intelligence Research Institute
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2014:
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2085:Brazier, John; Tsuchiya, Aki (2015).
1967:
1941:
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938:"NICE's cost effectiveness threshold"
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2897:Incremental cost-effectiveness ratio
2856:Incremental cost-effectiveness ratio
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557:Incremental cost-effectiveness ratio
547:Cost-Effectiveness Analysis Registry
489:outcomes in monetary terms. In 2018
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211:(ICER) can then be used to allocate
209:incremental cost-effectiveness ratio
101:adding citations to reliable sources
68:
2814:Routine health outcomes measurement
2394:Center for High Impact Philanthropy
1968:Smith, William (22 February 2019).
1765:
1390:Health and Quality of Life Outcomes
786:Health and Quality of Life Outcomes
727:Health and Quality of Life Outcomes
13:
2887:Clinical Quality Management System
2015:Roland, Denise (4 November 2019).
1942:Smith, William (24 January 2019).
398:People are neutral about risk; and
14:
2949:
1781:Dreaper, Jane (24 January 2013).
1584:Schlander, Michael (2010-05-23),
1493:(2): 325–8, author reply 329–31.
1089:Fanshel, Sol; Bush, J.W. (1970).
532:Value of a Statistical Life (VSL)
2232:Equal consideration of interests
1529:Health Economics, Policy and Law
1427:
1068:10.1097/00005650-196801000-00005
667:10.1111/j.1524-4733.2009.00515.x
424:Second, the study was "limited."
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2636:Famine, Affluence, and Morality
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470:Utilitarianism and the pandemic
267:Office of Technology Assessment
239:Americans with Disabilities Act
2600:Risk of astronomical suffering
1812:ECHOUTCOME European Project".
1499:10.1016/j.jhealeco.2009.11.001
985:Stetler, Pepper (2023-03-08).
902:
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773:
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690:
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1:
2892:Disability-adjusted life year
2384:Centre for Effective Altruism
2212:Disability-adjusted life year
1659:Social Science & Medicine
1213:Law and Contemporary Problems
1209:"Where Now for Saving Lives?"
575:
515:Wellbeing-adjusted Life Year
510:Disability-adjusted life year
411:Scottish Medicines Consortium
2499:Raising for Effective Giving
2424:Future of Humanity Institute
1731:Holmes, David (March 2013).
1671:10.1016/0277-9536(89)90030-0
923:10.1016/0047-2727(73)90002-9
880:10.1016/0168-8510(90)90421-9
845:10.1016/0167-6296(86)90020-2
417:made the following points.
379:health technology assessment
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7:
2861:Cost-effectiveness analysis
2650:Living High and Letting Die
2595:Neglected tropical diseases
1487:Journal of Health Economics
954:10.1136/bmj.39308.560069.BE
942:BMJ (Clinical Research Ed.)
911:Journal of Public Economics
833:Journal of Health Economics
500:
309:. The specific problem is:
205:cost-effectiveness analysis
162:Journal of Health Economics
10:
2954:
2902:Quality-adjusted life year
2866:Cost-minimization analysis
2794:Independent medical review
2364:Against Malaria Foundation
2257:Quality-adjusted life year
2145:. 16 May 2024. p. 28.
1355:10.1177/0272989X9101100212
1260:Health Policy and Planning
1178:Kaplan, Robert M. (1995).
248:
40:) is a generic measure of
34:quality-adjusted life year
2879:
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2822:
2776:
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2702:Effective Altruism Global
2694:
2629:The End of Animal Farming
2613:
2522:
2489:Nuclear Threat Initiative
2374:Animal Charity Evaluators
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2275:
2189:
2103:10.1007/s40258-015-0194-1
2060:10.1007/s11238-014-9434-3
1826:10.1007/s40273-014-0216-0
1541:10.1017/S1744133107004355
1520:Dolan, P (January 2008).
564:and measurements such as
280:
16:Measure of disease burden
2809:Health services research
2804:Health impact assessment
2657:The Most Good You Can Do
2570:Intensive animal farming
2555:Global catastrophic risk
2429:Future of Life Institute
1456:10.1177/0272989X07309642
1135:Health Services Research
486:Medical Research Council
2777:Health care evaluations
2758:Evidence-based medicine
2459:The Good Food Institute
2207:Demandingness objection
1444:Medical Decision Making
1343:Medical Decision Making
228:National Health Service
207:of any treatment. This
48:to assess the value of
2830:Hospital accreditation
2685:What We Owe the Future
2514:Wild Animal Initiative
2247:Moral circle expansion
1403:10.1186/1477-7525-1-80
1254:Sassi, Franco (2006).
1110:10.1287/opre.18.6.1021
948:(7616). BMJ: 358–359.
799:10.1186/1477-7525-1-80
740:10.1186/1477-7525-1-80
274:multiattribute utility
260:technology assessments
233:In 1989, the state of
194:
29:
2643:The Life You Can Save
2605:Wild animal suffering
1320:10.1287/opre.28.1.206
1273:10.1093/heapol/czl018
552:Cost-utility analysis
201:cost-utility analysis
180:Visual analogue scale
22:
2789:Clinical peer review
2267:Venture philanthropy
1913:10.1093/qjmed/hcq081
1896:"The cost of a QALY"
519:and Wellbeing Year (
316:improve this section
305:to meet Knowledge's
97:improve this section
2928:Health care quality
2799:Health care ratings
2751:Concepts of quality
2744:Health care quality
2504:Sentience Institute
2047:Theory and Decision
2021:Wall Street Journal
1308:Operations Research
1098:Operations Research
650:"QALYs: The Basics"
375:European Commission
46:economic evaluation
2871:Cost per procedure
2849:Costs and benefits
2585:Malaria prevention
2545:Economic stability
2530:Biotechnology risk
2484:Malaria Consortium
2449:Giving What We Can
2419:Fistula Foundation
2202:Charity assessment
2183:Effective altruism
1750:10.1038/nm0313-248
1027:The New York Times
570:Life Quality Index
480:Future development
369:As early as 1989,
30:
2910:
2909:
2768:Medical guideline
2763:Medical consensus
2710:
2709:
2622:Doing Good Better
2494:Open Philanthropy
2474:Mercy for Animals
2469:The Humane League
2343:Eliezer Yudkowsky
2308:William MacAskill
2283:Sam Bankman-Fried
2197:Aid effectiveness
1948:Pioneer Institute
1814:PharmacoEconomics
344:
343:
336:
307:quality standards
298:This section may
262:conducted by the
243:Louis W. Sullivan
133:
132:
125:
59:opportunity costs
2945:
2923:Health economics
2737:
2730:
2723:
2714:
2713:
2664:Practical Ethics
2313:Dustin Moskovitz
2303:Holden Karnofsky
2242:Marginal utility
2176:
2169:
2162:
2153:
2152:
2147:
2146:
2143:"HMT Green Book"
2139:
2133:
2132:
2122:
2082:
2073:
2072:
2062:
2038:
2032:
2031:
2029:
2027:
2012:
2006:
2005:
2003:
2002:
1991:
1985:
1984:
1982:
1980:
1965:
1959:
1958:
1956:
1954:
1939:
1933:
1932:
1930:
1928:
1915:
1891:
1882:
1881:
1879:
1873:. Archived from
1872:
1863:
1854:
1853:
1808:
1797:
1796:
1794:
1793:
1778:
1763:
1762:
1752:
1728:
1709:
1708:
1703:. Archived from
1697:
1691:
1690:
1654:
1648:
1647:
1616:Health Economics
1611:
1605:
1604:
1603:
1602:
1596:
1581:
1575:
1574:
1572:
1571:
1565:
1559:. Archived from
1526:
1517:
1511:
1510:
1482:
1476:
1475:
1439:
1433:
1432:
1431:
1425:
1415:
1405:
1381:
1375:
1374:
1338:
1332:
1331:
1303:
1294:
1293:
1275:
1251:
1245:
1244:
1204:
1198:
1197:
1195:
1194:
1189:. pp. 31–60
1184:
1175:
1169:
1168:
1158:
1126:
1120:
1119:
1117:
1116:
1095:
1086:
1080:
1079:
1051:
1045:
1044:
1042:
1041:
1024:
1017:
1011:
1010:
1008:
1007:
990:
982:
976:
975:
965:
933:
927:
926:
906:
900:
899:
863:
857:
856:
828:
822:
821:
811:
801:
777:
771:
770:
760:
742:
718:
712:
711:
709:
708:
694:
688:
687:
669:
645:
634:
633:
631:
630:
616:
607:
606:
604:
603:
598:. September 2013
588:
438:vested interests
339:
332:
328:
325:
319:
293:
292:
285:
128:
121:
117:
114:
108:
77:
69:
2953:
2952:
2948:
2947:
2946:
2944:
2943:
2942:
2938:Life expectancy
2913:
2912:
2911:
2906:
2875:
2844:
2818:
2772:
2746:
2741:
2711:
2706:
2690:
2609:
2575:Land use reform
2518:
2434:Founders Pledge
2409:Evidence Action
2347:
2271:
2227:Earning to give
2185:
2180:
2150:
2141:
2140:
2136:
2083:
2076:
2039:
2035:
2025:
2023:
2013:
2009:
2000:
1998:
1993:
1992:
1988:
1978:
1976:
1966:
1962:
1952:
1950:
1940:
1936:
1926:
1924:
1892:
1885:
1877:
1870:
1864:
1857:
1809:
1800:
1791:
1789:
1779:
1766:
1737:Nature Medicine
1729:
1712:
1699:
1698:
1694:
1655:
1651:
1612:
1608:
1600:
1598:
1594:
1582:
1578:
1569:
1567:
1563:
1524:
1518:
1514:
1483:
1479:
1440:
1436:
1426:
1382:
1378:
1339:
1335:
1304:
1297:
1252:
1248:
1225:10.2307/1191310
1205:
1201:
1192:
1190:
1182:
1176:
1172:
1127:
1123:
1114:
1112:
1093:
1087:
1083:
1052:
1048:
1039:
1037:
1019:
1018:
1014:
1005:
1003:
993:Washington Post
983:
979:
934:
930:
907:
903:
864:
860:
829:
825:
778:
774:
719:
715:
706:
704:
696:
695:
691:
654:Value in Health
646:
637:
628:
626:
618:
617:
610:
601:
599:
590:
589:
582:
578:
562:Quality of life
527:Life-years lost
505:Related units:
503:
482:
383:Ariel Beresniak
340:
329:
323:
320:
313:
294:
290:
283:
251:
197:
157:
129:
118:
112:
109:
94:
78:
67:
17:
12:
11:
5:
2951:
2941:
2940:
2935:
2933:Medical ethics
2930:
2925:
2908:
2907:
2905:
2904:
2899:
2894:
2889:
2883:
2881:
2877:
2876:
2874:
2873:
2868:
2863:
2858:
2852:
2850:
2846:
2845:
2843:
2842:
2837:
2832:
2826:
2824:
2820:
2819:
2817:
2816:
2811:
2806:
2801:
2796:
2791:
2786:
2784:Clinical audit
2780:
2778:
2774:
2773:
2771:
2770:
2765:
2760:
2754:
2752:
2748:
2747:
2740:
2739:
2732:
2725:
2717:
2708:
2707:
2705:
2704:
2698:
2696:
2692:
2691:
2689:
2688:
2681:
2674:
2667:
2660:
2653:
2646:
2639:
2632:
2625:
2617:
2615:
2611:
2610:
2608:
2607:
2602:
2597:
2592:
2590:Mass deworming
2587:
2582:
2580:Life extension
2577:
2572:
2567:
2565:Global poverty
2562:
2557:
2552:
2547:
2542:
2537:
2535:Climate change
2532:
2526:
2524:
2520:
2519:
2517:
2516:
2511:
2509:Unlimit Health
2506:
2501:
2496:
2491:
2486:
2481:
2476:
2471:
2466:
2461:
2456:
2454:Good Food Fund
2451:
2446:
2441:
2436:
2431:
2426:
2421:
2416:
2411:
2406:
2401:
2396:
2391:
2386:
2381:
2376:
2371:
2366:
2361:
2355:
2353:
2349:
2348:
2346:
2345:
2340:
2335:
2330:
2325:
2320:
2315:
2310:
2305:
2300:
2298:Hilary Greaves
2295:
2290:
2285:
2279:
2277:
2273:
2272:
2270:
2269:
2264:
2262:Utilitarianism
2259:
2254:
2249:
2244:
2239:
2234:
2229:
2224:
2219:
2217:Disease burden
2214:
2209:
2204:
2199:
2193:
2191:
2187:
2186:
2179:
2178:
2171:
2164:
2156:
2149:
2148:
2134:
2097:(6): 557–565.
2074:
2053:(4): 525–538.
2033:
2007:
1986:
1960:
1934:
1906:(9): 715–720.
1883:
1880:on 2015-08-14.
1855:
1798:
1764:
1710:
1707:on 2016-10-08.
1692:
1665:(4): 299–308.
1649:
1606:
1576:
1512:
1477:
1434:
1376:
1333:
1295:
1266:(5): 402–408.
1246:
1199:
1170:
1141:(2): 118–133.
1121:
1104:(6): 1021–66.
1081:
1046:
1029:. 1992-09-01.
1012:
977:
928:
917:(2): 147–157.
901:
874:(3): 199–208.
858:
823:
772:
713:
689:
635:
608:
579:
577:
574:
573:
572:
559:
554:
549:
544:
542:Case mix index
535:
534:
529:
524:
513:
502:
499:
481:
478:
465:Rule of rescue
442:
441:
434:
431:
428:
425:
422:
403:
402:
399:
396:
393:
390:
342:
341:
297:
295:
288:
282:
279:
250:
247:
220:United Kingdom
196:
193:
184:
183:
177:
173:
170:Time-trade-off
156:
153:
131:
130:
81:
79:
72:
66:
63:
42:disease burden
15:
9:
6:
4:
3:
2:
2950:
2939:
2936:
2934:
2931:
2929:
2926:
2924:
2921:
2920:
2918:
2903:
2900:
2898:
2895:
2893:
2890:
2888:
2885:
2884:
2882:
2878:
2872:
2869:
2867:
2864:
2862:
2859:
2857:
2854:
2853:
2851:
2847:
2841:
2838:
2836:
2833:
2831:
2828:
2827:
2825:
2823:Accreditation
2821:
2815:
2812:
2810:
2807:
2805:
2802:
2800:
2797:
2795:
2792:
2790:
2787:
2785:
2782:
2781:
2779:
2775:
2769:
2766:
2764:
2761:
2759:
2756:
2755:
2753:
2749:
2745:
2738:
2733:
2731:
2726:
2724:
2719:
2718:
2715:
2703:
2700:
2699:
2697:
2693:
2687:
2686:
2682:
2680:
2679:
2675:
2673:
2672:
2671:The Precipice
2668:
2666:
2665:
2661:
2659:
2658:
2654:
2652:
2651:
2647:
2645:
2644:
2640:
2638:
2637:
2633:
2631:
2630:
2626:
2624:
2623:
2619:
2618:
2616:
2612:
2606:
2603:
2601:
2598:
2596:
2593:
2591:
2588:
2586:
2583:
2581:
2578:
2576:
2573:
2571:
2568:
2566:
2563:
2561:
2560:Global health
2558:
2556:
2553:
2551:
2548:
2546:
2543:
2541:
2540:Cultured meat
2538:
2536:
2533:
2531:
2528:
2527:
2525:
2521:
2515:
2512:
2510:
2507:
2505:
2502:
2500:
2497:
2495:
2492:
2490:
2487:
2485:
2482:
2480:
2477:
2475:
2472:
2470:
2467:
2465:
2464:Good Ventures
2462:
2460:
2457:
2455:
2452:
2450:
2447:
2445:
2442:
2440:
2437:
2435:
2432:
2430:
2427:
2425:
2422:
2420:
2417:
2415:
2412:
2410:
2407:
2405:
2402:
2400:
2397:
2395:
2392:
2390:
2387:
2385:
2382:
2380:
2379:Animal Ethics
2377:
2375:
2372:
2370:
2367:
2365:
2362:
2360:
2357:
2356:
2354:
2352:Organizations
2350:
2344:
2341:
2339:
2336:
2334:
2331:
2329:
2326:
2324:
2321:
2319:
2316:
2314:
2311:
2309:
2306:
2304:
2301:
2299:
2296:
2294:
2291:
2289:
2286:
2284:
2281:
2280:
2278:
2274:
2268:
2265:
2263:
2260:
2258:
2255:
2253:
2250:
2248:
2245:
2243:
2240:
2238:
2235:
2233:
2230:
2228:
2225:
2223:
2220:
2218:
2215:
2213:
2210:
2208:
2205:
2203:
2200:
2198:
2195:
2194:
2192:
2188:
2184:
2177:
2172:
2170:
2165:
2163:
2158:
2157:
2154:
2144:
2138:
2130:
2126:
2121:
2116:
2112:
2108:
2104:
2100:
2096:
2092:
2088:
2081:
2079:
2070:
2066:
2061:
2056:
2052:
2048:
2044:
2037:
2022:
2018:
2011:
1996:
1990:
1975:
1971:
1964:
1949:
1945:
1938:
1923:
1919:
1914:
1909:
1905:
1901:
1897:
1890:
1888:
1876:
1869:
1862:
1860:
1851:
1847:
1843:
1839:
1835:
1831:
1827:
1823:
1819:
1815:
1807:
1805:
1803:
1788:
1784:
1777:
1775:
1773:
1771:
1769:
1760:
1756:
1751:
1746:
1742:
1738:
1734:
1727:
1725:
1723:
1721:
1719:
1717:
1715:
1706:
1702:
1696:
1688:
1684:
1680:
1676:
1672:
1668:
1664:
1660:
1653:
1645:
1641:
1637:
1633:
1629:
1625:
1621:
1617:
1610:
1597:on 2016-10-25
1593:
1589:
1588:
1580:
1566:on 2016-08-03
1562:
1558:
1554:
1550:
1546:
1542:
1538:
1534:
1530:
1523:
1516:
1508:
1504:
1500:
1496:
1492:
1488:
1481:
1473:
1469:
1465:
1461:
1457:
1453:
1449:
1445:
1438:
1430:
1423:
1419:
1414:
1409:
1404:
1399:
1395:
1391:
1387:
1380:
1372:
1368:
1364:
1360:
1356:
1352:
1348:
1344:
1337:
1329:
1325:
1321:
1317:
1314:(1): 206–24.
1313:
1309:
1302:
1300:
1291:
1287:
1283:
1279:
1274:
1269:
1265:
1261:
1257:
1250:
1242:
1238:
1234:
1230:
1226:
1222:
1218:
1214:
1210:
1203:
1188:
1181:
1174:
1166:
1162:
1157:
1152:
1148:
1144:
1140:
1136:
1132:
1125:
1111:
1107:
1103:
1099:
1092:
1085:
1077:
1073:
1069:
1065:
1061:
1057:
1050:
1036:
1032:
1028:
1023:
1016:
1002:
998:
994:
989:
981:
973:
969:
964:
959:
955:
951:
947:
943:
939:
932:
924:
920:
916:
912:
905:
897:
893:
889:
885:
881:
877:
873:
869:
868:Health Policy
862:
854:
850:
846:
842:
838:
834:
827:
819:
815:
810:
805:
800:
795:
791:
787:
783:
776:
768:
764:
759:
754:
750:
746:
741:
736:
732:
728:
724:
717:
703:
699:
693:
685:
681:
677:
673:
668:
663:
659:
655:
651:
644:
642:
640:
625:
621:
615:
613:
597:
593:
587:
585:
580:
571:
567:
563:
560:
558:
555:
553:
550:
548:
545:
543:
540:
539:
538:
533:
530:
528:
525:
522:
518:
514:
511:
508:
507:
506:
498:
496:
495:discount rate
492:
487:
477:
473:
471:
466:
461:
457:
453:
449:
445:
439:
435:
432:
429:
426:
423:
420:
419:
418:
416:
412:
407:
400:
397:
394:
391:
388:
387:
386:
384:
380:
376:
372:
367:
364:
360:
355:
353:
350:independent,
349:
338:
335:
327:
317:
312:
308:
304:
303:
296:
287:
286:
278:
275:
270:
268:
265:
261:
257:
246:
244:
240:
236:
231:
229:
225:
221:
216:
214:
210:
206:
202:
192:
189:
181:
178:
174:
171:
168:
167:
166:
164:
163:
152:
148:
145:
142:
137:
127:
124:
116:
106:
102:
98:
92:
91:
87:
82:This section
80:
76:
71:
70:
62:
60:
54:
51:
47:
43:
39:
35:
27:
21:
2901:
2683:
2676:
2669:
2662:
2655:
2648:
2641:
2634:
2627:
2620:
2439:GiveDirectly
2359:80,000 Hours
2333:Peter Singer
2328:Derek Parfit
2318:Yew-Kwang Ng
2293:Nick Bostrom
2256:
2137:
2094:
2090:
2050:
2046:
2036:
2024:. Retrieved
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