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|Title:||Income effects of reduced health and health effects of reduced income|
O'Brien, Bernie J.
Centre for Health Economics and Policy Analysis
|Keywords:||Health Status Indicators;Income;Socioeconomic Factors;Quality-Adjusted Life Years;Mental Health|
|Series/Report no.:||CHEPA working paper series 99-02|
|Abstract:||There is increasing use of multi-attribute health state utility systems such as the Health Utilities Index (HUI) and the EuroQol (now EQ-5D). Proponents argue that data from such systems can be used in cost-utility analysis (CUA) to calculate quality-adjusted life years (QALYs) in a way that is unrelated to income. However, income can influence QALY measurement at two stages: raters' income when they value health states and patients' income when they are categorized to health states. We have reviewed the most popular utility systems regarding how these income effects are handled and assess the implications for the measurement of QALYs using these systems. Categorization within a valuation system will primarily reflect the direct effects of a patient's health. However, certain domains - in particular, mental health and social function - are likely to reflect the effects of income loss due to illness. We argue that these health effects of reduced income are not separable from primary health effects. At the valuation stage, raters may make inferences about the effects of reduced health on income and hence on general wellbeing. In principle, these inferences can be removed by asking raters to assume income would remain unchanged in a given health state. Only the HUI has actively ruled-out income inferences at valuation, with the other instruments ambiguous in this respect. We argue that health state valuation systems should actively rule-in and out income inferences at valuation, that ruling-in income inferences will make instruments less useful outside the location from which the raters were drawn and that the risk of double-counting if income inferences are ruled in can be avoided if greater detail is given to the rater about which health domains are affected by income loss.|
|Description:||Mark Sculpher and Bernie O'Brien.|
Bibliography: p. 21-22.
|Appears in Collections:||CHEPA Working Paper Series|
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