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Arch Hellen Med, 18(2), March-April 2001, 114-130


Quality of life and QALYs in the measurement of health

University of Athens, Athens, Greece

Health status measurement has been an important topic of investigation by epidemiologists, demographers, statisticians, psychologists, and econo-mists. Different approaches have been explored to conceptualise health and to analyse health related issues of quality of life. Health is a multidimensional phenomenon including not only medical or clinical aspects but also other important dimensions related to the physical, psychological and social aspects of well-being. This paper reviews the methods explored by various disciplines for measuring quality of life using both generic instruments, based on general population studies and disease specific instruments, designed to assess the evolution of a disease and to evaluate the impact of alternative therapies or medical interventions. The concept of Quality Adjusted Life Years (QALYs) has become a popular topic among doctors and economists during the last two decades. It combines "quantity" i.e., life expectancy with "quality" adjusted life years. The alternative approaches to estimation of QALYs are explored and reference is made to simple rating methods such as the category and the magnitude methods. Sound theoretical approaches, based on utility theory, i.e., the Time Trade Off and the Standard Gamble are discussed. The Standard Gamble method, based on Von Neumann Morgenstern cardinal utility is analysed and the psychological assumption for deriving utility based values are discussed. Since Greece is currently in the process of designing a comprehensive regional health policy, the methodology proposed by this paper could be useful for setting priorities among the regions and devising effective and efficient criteria for resource allocation.

Key words: Health measurement, Health produetion, QALYs, Quality of life, Standard Gamble.

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