Cost-value Analysis in Health Care: Making Sense out of QALYs

Eric Nord's book is required reading for all those interested in resource allocation. It is largely a book on health economics, but the importance of the issues discussed and the clarity of this book mean that it is relevant to all those involved in resource allocation. One of the more common objections to QALYs (Quality Adjusted Life Years) is that they focus on maximising the benefit produced by health care without paying attention to other factors relevant to allocation. One of the basic theses of Nord's book is that there is something right about this line of criticism and he sets out to correct cost-effectiveness studies by building into them societal concerns for the way in which health care resources are distributed. In chapter four he argues that the standard approach to QALYs is inconsistent with two major societal concerns about fairness. First it violates the strength with which people wish to give priority to the severely ill over the less severely ill at the expense of the total amount of health produced. Second, …