FarmakoEkonomi

© 2015
Deni Iskandar, S.Si., Apt., MPH.
@deniiskandar
Benefit Measure & Health Related
Quality-of-Life measures
• Benefit Measure
• Overview HRQL
• Framework HRQL
• Deriving HRQL score
• Other consideration on HRQL
• DALY
• QALY
Benefit Measure

Cost of Illness
Cost-Minimization Analysis
Cost-Effectiveness Analysis
Cost-Benefit Analysis
BENEFIT?
Cost-Utility Analysis
Benefit Measure

Type
Cost-benefit analysis Cost and benefit in money term.
Allow all types of service to be compared, but
difficult to measure.
Cost-utility analysis Adopts an index of benefit that is common
across different types of services.
Commonly used QALY (quality-adjusted life
year).
Cost-effectiveness analysis Outcome in natural units only.
Ex: years of life gained, number of children
immunized or days of palliative care.
Cost-minimization analysis If outcome is the same for all options.
Seek the lowest-cost way of achieving outcome.
Benefit Measure
since the same unit of
measurement is used in all
cases, all potential
developments can be compared
Advantage of on the same basis
measuring benefit in
money terms: in principle possible to make
judgements not only on relative
priority, but also on whether or
not something is worth doing at
all
Willingness to pay: maximum amount an individual is willing to
sacrifice to procure a good or avoid something undesirable
Benefit Measure
Benefit Measure

Alternative units of measurement

natural units on a one-dimensional scale

units of a cardinal utility function which maps

the multi-dimensional concept of health into a
scalar index

units of money
Overview HRQL
Framework HRQL

A preference score is a number between 0 and 1

Preference score refers to

a single health state

HRQL score is essentially

an overall preference
score for multiple health
states
Framework HRQL
How HRQL scores are generated
1. Preference scores for a set number of health states are
obtained from a large sample of people

2. Statistical analyses are conducted on these reference

scores

3. These values are translated into a type of score sheet

that requires the user to check off broad categories of
health states

4. It translates these health states into an overall HRQL

score
Framework HRQL
Deriving HRQL score
Preference - weighted generic instruments
Deriving HRQL score
Preference - weighted generic instruments
Deriving HRQL score
Large Health Surveys

• National health survey

• Estimating average HRQL for people with and without
disease
• Estimating overall HRQL associated with a risk factor for
multiple disease

Ex:
MEPS (Medical Expenditure Panel Survey) has been used to estimate the HRQL
of people with and without health insurance and the HRQL of people with
varying levels of income (Muennig, Franks, and Gold, 2005; Muennig and
others, 2005).
Other consideration on HRQL

Effect of Age on HRQL

Effect of Disease Stage

on HRQL

Effect of an Intervention
on HRQL

Use of HRQL Scores in

Diverse Populations
DALY
• First developed in 1993 in the World Development Report
of the World Bank
• Measure the loss of life years in full health starting from a
standardized life expectancy of 80 years for men and 82.5
years for women
• Morbidity weights determined by experts are then used to
assess states with less than full health
DALY
• First developed in 1993 in the World Development Report
of the World Bank
• Measure the loss of life years in full health starting from a
standardized life expectancy of 80 years for men and 82.5
years for women
• Morbidity weights determined by experts are then used to
assess states with less than full health

Example of DALY
calculation. Reproduced
from Struijk et al. [22].
May et al. BMC
Medicine 2015 13:39 doi:1
0.1186/s12916-015-0287-6
QALY
• Based on the work by KLARMAN ET AL. (1968), who first
captured explicitly the number of life years gained and
changes in the quality of life in a single index
• Health state is assigned a morbidity weight. Determined
by surveying the people concerned by the intervention
QALY
• The number of QALYs of a person is sound by multiplying
the expected duration of a health state with its morbidity
index and summing up these numbers
• The utility of an intervention is given by the number of
QALYs gained
QALY

Association between Lifestyle Factors and Quality-Adjusted Life Years in the EPIC-
NL Cohort