Publications [#301687] of Peter A Ubel

Journal Articles

1. Ubel, PA; Nord, E; Gold, M; Menzel, P; Prades, JL; Richardson, J, Improving value measurement in cost-effectiveness analysis., Medical care, vol. 38 no. 9 (September, 2000), pp. 892-901, ISSN 0025-7079 [10982111], [doi]
   (last updated on 2026/01/17)

   Abstract:
   

   Objective

   Before cost-effectiveness analysis (CEA) can fulfill its promise as a tool to guide health care allocation decisions, the method of incorporating societal values into CEA may need to be improved.

   Design

   The study design was a declarative exposition of potential fallacies in the theoretical underpinnings of CEA. Two values held by many people-preferences for giving priority to severely ill patients and preferences to avoid discrimination against people who have limited treatment potential because of disability or chronic illness-that are not currently incorporated into CEA are discussed.

   Conclusions

   Traditional CEA, through the measurement of quality-adjusted life years (QALYs), is constrained because of a "QALY trap." If, for example, saving the life of a person with paraplegia is equally valuable as saving the life of a person without paraplegia, then current QALY methods force us to conclude that curing paraplegia brings no benefit. Basing cost-effectiveness measurement on societal values rather than QALYs may allow us to better capture public rationing preferences, thereby escaping the QALY trap. CEA can accommodate a wider range of such societal values about fairness in its measurements by amending its methodology.