BMJ  2005;330:1382-1384 (11 June), doi:10.1136/bmj.330.7504.1382

Education and debate

Prognosis without treatment as a modifier in health economic assessments

¹ Clinical Pharmacology Unit, Western General Hospital, Edinburgh EH4 2XU, ² Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ, ³ Edinburgh Cancer Centre, Western General Hospital

How long someone has to live intuitively seems important in rationing decisions. Incorporating it into economic assessments, as described here, could make decisions fairer

The first 150 words of the full text of this article appear below.

Introduction

Explicit rationing—decisions not to fund certain treatments—has become a fact of life in many healthcare systems.^1-4 Health economic assessments often underpin rationing decisions, although it remains unclear whether society's values are well reflected by the utilitarian approach of maximising the units of health attainable from available resources.^{5 6} Health economic assessments are used to determine the additional cost per unit of health gain for different treatment options. Cost effectiveness analysis is the most common method of assessment^{7 8} and, for life shortening conditions, primarily focuses on the additional cost per life year gained. We propose that prognosis without treatment is an important contextual modifier of life years gained in evaluating treatments for life shortening conditions. We present initial data supporting this hypothesis and describe resource allocation strategies that use this information.

Limitations of life years gained

Life years gained represent the extra life expectancy resulting from a treatment. By definition, the comparison is with the life expectancy . . . [Full text of this article]

QALYs and contextual modifiers

Evidence for use of prognosis without treatment

What further work is required?

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