How much should be spent to save or enhance a human life? There is only so much society can afford to spend on health care for its entire population. So certainly there has to be a limit on how much it can spend on any one individual.
But how can a fair and rational decision be made by society, taking into consideration both cost and the benefit to the individual?
Although many in the USA would paint discussion of such considerations as necessarily leading to “death juries”, the British National Health System has long had and has sought to improve a proper formula for providing medicine under its ‘free’ program.
We learned about this from young visitors while vacationing at the shore. We found the subject to be fascinating.
As far as we have come to understand, the Brits take into consideration quality of life and likely duration.
To describe their approach, we will excerpt from learned articles posted on the Internet.
The links will enable those interested to learn more:
The British National Institute for Health and Care Excellence (NICE)<a href="https://www.nice.org.uk/abouthe National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care.
WIKIPEDIA: The quality-adjusted life year or quality-adjusted life-year (QALY) is a measure of disease burden, including both the quality and the quantity of life lived.[1][2] It is used in assessing the value for money of a medical intervention. According to Pliskin et al., The QALY model requires utility independent, risk neutral, and constant proportional tradeoff behaviour.[3]
The QALY is based on the number of years of life that would be added by the intervention. Each year in perfect health is assigned the value of 1.0 down to a value of 0.0 for being dead. If the extra years would not be lived in full health, for example if the patient would lose a limb, or be blind or have to use a wheelchair, then the extra life-years are given a value between 0 and 1 to account for this.[citation needed] Under certain methods, such as the EQ-5D, the QALY can be a negative number.
The NICE cost-effectiveness threshold: what it is and what that means.
Abstract
The National Institute for Health and Clinical Excellence (NICE) has been using a cost-effectiveness threshold range between 20,000 pounds sterling and 30,000 pounds sterling for over 7 years.
What the cost-effectiveness threshold represents, what the appropriate level is for NICE to use, and what the other factors are that NICE should consider have all been the subject of much discussion.
What is the incremental cost-effectiveness ratio (ICER)?
The incremental cost-effectiveness ratio (ICER) often comes up when talking about drug comparisons, but what is it and how does it relate to medicines?
A health economic evaluation involves a comparative analysis where a therapeutic intervention is compared to another health technology.
The results of this analysis are expressed by means of an incremental cost-effectiveness ratio (ICER), which is defined as the ratio of the change in costs of a therapeutic intervention (compared to the alternative, such as doing nothing or using the best available alternative treatment) to the change in effects of the intervention.
Incremental cost-effectiveness ratio (ICER) = (C1 – C0) / (E1 – E0)
Where C1 is the cost of the medicine; C0 is the cost of the comparator technology; E1 and E0 are the consequences of the medicine and the comparator, respectively.
The change in effects is usually measured in terms of the number of life-years gained or quality-adjusted life years gained by the intervention.
