Logical Inconsistencies in the Health Years in Total and Equal Value of Life- Years Gained

Presenter: A /Prof Mike Paulden

Mike Paulden is an Associate Professor at the School of Public Health, University of
Alberta, Canada. His research focuses on the methodological foundations of health
technology assessment, critically evaluating conventions surrounding cost-
effectiveness thresholds and medicine pricing, discounting and time preference,
and the integration of equity considerations into resource allocation decisions.

Abstract:
Objectives: This study aimed to assess whether recently proposed alternatives to
the quality-adjusted life-year (QALY), intended to address concerns about
discrimination, are suitable for informing resource allocation decisions.
Methods: We consider 2 alternatives to the QALY: the health years in total (HYT),
recently proposed by Basu et al, and the equal value of life-years gained (evLYG),
currently used by the Institute for Clinical and Economic Review. For
completeness we also consider unweighted life-years (LYs). Using a hypothetical
example comparing 3 mutually exclusive treatment options, we consider how
calculations are performed under each approach and whether the resulting
rankings are logically consistent. We also explore some further challenges that
arise from the unique properties of the HYT approach.
Results: The HYT and evLYG approaches can result in logical inconsistencies that
do not arise under the QALY or LY approaches. HYT can violate the independence
of irrelevant alternatives axiom, whereas the evLYG can produce an unstable
ranking of treatment options. HYT have additional issues, including an
implausible assumption that the utilities associated with health-related quality of
life and LYs are "separable," and a consideration of "counterfactual" health-
related quality of life for patients who are dead.
Conclusions: The HYT and evLYG approaches can result in logically inconsistent
decisions. We recommend that decision makers avoid these approaches and that
the logical consistency of any approaches proposed in future be thoroughly
explored before considering their use in practice.

Location: Room 515, Level 5, 207 Bouverie Street or Online: Zoom link sent after registration
Registration (Essential) https://go.unimelb.edu.au/54k2
Contact: health-economics@unimelb.edu.au