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Searchers vs surveyors in estimating the monetary value of a QALY: resolving a nasty dilemma for NICE

  • Rachel Baker (a1) (a2), Sue Chilton (a3) (a4), Cam Donaldson (a5) (a6) (a7), Michael Jones-Lee (a8) (a9), Emily Lancsar (a10) (a11) (a12), Helen Mason (a13), Hugh Metcalf (a14) (a15), Mark Pennington (a16) and John Wildman (a17) (a18)
  • DOI:
  • Published online: 22 August 2011

Recently, for many health economics researchers, empirical estimation of the monetary valuation of a quality-adjusted life year (QALY) has become an important endeavour. Different philosophical and practical approaches to this have emerged. On the one hand, there is a view that, with health-care budgets set centrally, decision-making bodies within the system can iterate, from observation of a series of previous decisions, towards the value of a QALY, thus searching for such a value. Alternatively, and more consistent with the approach taken in other public sectors, individual members of the public are surveyed with the aim of directly eliciting a preference-based – also known as a willingness-to-pay-based (WTP-based) – value of a QALY. While the former is based on supply-side factors and the latter on demand, both in fact suffer from informational deficiencies. Sole reliance on either would necessitate an acceptance or accommodation of chronic inefficiencies in health-care resource allocation. On the basis of this observation, this paper makes the case that in order to approach optimal decision making in health-care provision, a framework incorporating and thus, to a degree, reconciling these two approaches is to be preferred.

Corresponding author
Correspondence to: Cam Donaldson, Yunus Chair in Social Business and Health, NIHR Senior Investigator and Director, Yunus Centre for Social Business and Health, Institute of Applied Health Research, Glasgow Caledonian University, Level 3 Buchanan House, Cowcaddens Road, Glasgow G4 0BA, UK. Email:
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J. Appleby , N. Devlin , D. Parkin , K. Chalkidou M. Buxton (2009), Searching for cost effectiveness thresholds in the NHS, Health Policy, 91: 239245.

R. Baker , I. Bateman , C. Donaldson , M. Jones-Lee , E. Lancsar , G. Loomes , H. Mason , M. Odejar , J.-L. Pinto Prades , A. Robinson , M. Ryan , P. Shackley , R. Smith , R. Sugden , J. Wildman (2010), Weighting and valuing quality-adjusted life-years using stated preference methods: preliminary results from the Social Value of a QALY project, Health Technology Assessment, 14(27).

R. Baker , S. Chilton , M. Jones-Lee H. Metcalf (2008), Valuing lives equally: defensible premise or unwarranted compromise?, Journal of Risk and Uncertainty, 36: 125138.

A. Bate , C. Donaldson M. Murtagh (2007), Managing to manage scarce resources in the English NHS. What can economics teach? What can economics learn?, Health Policy, 84: 249261.

J. Broome (2004), Weighing Lives, Oxford: Oxford University Press.

W. Brouwer , J. van Exel , R. Baker C. Donaldson (2008), The new myth: the social value of the QALY, PharmacoEconomics, 26(1): 14.

A. Culyer , C. McCabe , A. Briggs , K. Claxton , M. Buxton , R. Akehurst , M. Sculpher J. Brazier (2007), Searching for a threshold, not setting one: the role of the National Institute for Health and Clinical excellence, Journal of Health Services Research and Policy, 12: 5658.

N. Devlin D. Parkin (2004), Does NICE have a cost-effectiveness threshold and what other factors influence its decisions?, Health Economics, 13: 437452.

C. Donaldson , S. Birch A. Gafni (2002), The pervasiveness of the ‘distribution problem’ in economic evaluation in health care, Health Economics, 11: 5570.

K. Lamiraud , K. Von Bremen C. Donaldson (2009), The impact of information on patient preferences in different delivery patterns: prescription versus OTC, Health Policy, 93: 102110.

S. Martin , N. Rice P. C. Smith (2008), Does health care spending improve health outcomes? Evidence from English programme budgeting data, Journal of Health Economics, 27: 826842.

C. McCabe , K. Claxton A. J. Culyer (2008), The NICE cost-effectiveness threshold: what it is and what it means, Pharmacoeconomics, 26: 733744.

J. L. Pinto-Prades , G. Loomes R. Brey (2009), Trying to estimate a monetary value for the QALY, Journal of Health Economics, 28: 553562.

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Health Economics, Policy and Law
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