The economics of measuring quality of life by the standard gamble method
Keywords:
quality of life, measurement, cost-effectiveness analysis, von Neumann-Morgenstern utilities, Romanian well-being indexAbstract
Of the countless methods for measuring the quality of life (QOL) that have been proposed and analyzed by the vast, multi-disciplinary literature over the past decades, only a select few are alluded to in Romanian scientific circles, and even fewer are actually implemented in practical applications. In adapting existing techniques and engineering a viable measurement system specific to Romania, there exists an important opportunity to re-evaluate the merits and shortcomings of established approaches. As a specific example, we consider the Standard Gamble (SG) method of eliciting “subjective utilities” related to particular health states. The re-evaluation is accomplished from three perspectives: theoretic consistency, interpretability and practicality. It is demonstrated that consistent with economic theory, the appropriate interpretation of SG derived measures is that of a Hicksian change in welfare valuation, rather than a cardinal measure of preferences. A practical consequence of the latter is that SG will necessarily produce a higher QOL value for individuals exhibiting more risk aversion. This leads us to contemplate that in fact SG may be a more appropriate methodology in other contexts, not necessarily health-related, where quality of life may indeed be correlated with the willingness to take risks.References
• Ardelean, L., C. Lupas, D. Spatarel, and M. Stoleru (2009), Calitatea vieţii la personalul din domeniul sanătăţii mintale. Revista de Neurologieşi Psihiatrie a Copilului şi Adolescentului din România 12(4), 54-64.
• Basu, A., W. Dale, A. Elstein, and D. Meltzer (2009), A linear index for predicting joint health-states utilities from single health-states utilities. Health economics 18(4), 403-19.
• Basu, A., W. Dale, A. Elstein, and D. Meltzer (2010), A time tradeoff method for eliciting partner’s quality of life due to patient’s health states in prostate cancer. Medical Decision Making 30(3), 355-65.
• Basu, A. and D. Meltzer (2005), Implications of spillover effects within the family for medical cost-effectiveness analysis. Journal of health economics 24(4), 751-73.
• Baumol, W. J. (1958), The cardinal utility which is ordinal. The Economic Journal 68(272), 665-672.
• Bell, D. E. and H. Raiffa (1982), Marginal value and intrinsic risk aversion. In H. Kunreuther (Ed.), Risk: A Seminar Series, Laxenburg, Austria, pp. 325-349. IIASA.
• Bravata, D. M., L. M. Nelson, A. M. Garber, and M. K. Goldstein (2010), Invariance and inconsistency in utility ratings. Medical Decision Making 25(2), 158-67.
• Buckingham, K. and N. Devlin (2006), A theoretical framework for TTO valuations of health. Health economics 15(10), 1149-54.
• Campian, R. S., C. Amariei, B. Crisan, G. Baciut, M. Baciut, O. Lucaciu, and A. Sava (2008), Calitatea vietii corelata cu sanatatea orala si cu cancerul oral si maxilofacial. Working Paper.
• Diener, E. and E. Suh (1997), Measuring quality of life: Economic, social, and subjective indicators. Social Indicators Research 40(1), 189-216.
• Dyer, J. S. and R. K. Sarin (1982), Relative risk aversion. Management Science 28, 875–886.
• Ellsberg, D. (1954), Classic and current notions of “measurable utility". The Economic Journal 64(255), 528-56.
• Farquhar, P. H. (1984), Utility assessment methods. Mangement Science 30(11), 1283–1300.
• Fishburn, P. C. (1989), Retrospective on the utility theory of von neumann and morgenstern. Journal of Risk and Uncertainty 2(2), 127-158.
• Giacaman, R., A. Mataria, V. Nguyen-Gillham, R. A. Safieh, A. Stefanini, and S. Chatterji (2007), Quality of life in the Palestinian context: an inquiry in war-like conditions. Health policy 81(1), 68-84.
• Hellinger, F. J. (1989), Expected utility theory and risky choices with health outcomes. Medical Care 27(3), 273-279.
• Karnofsky, D. A. and J. H. Burchenal (1949), The clinical evaluation of chemotherapeutic agents in cancer. In C. M. Maclead (Ed.), Evaluation of chemotherapeutic agents, New York, pp. 191-205. Columbia University Press.
• Larson, S. (2010), Regional well-being in tropical Queensland, Australia: developing a dissatisfaction index to inform government policy. Environment and Planning A 42(12), 2972-2989.
• Lenert, L. A. and R. M. Kaplan (2000), Validity and interpretation of preference-based measures of health-related quality of life. Medical care 38(9, Suppliment II), 138-150.
• Lenert, L. A., A. Sturley, and M. Rupnow (2003), Toward Improved Methods for Measurement of Utility: Automated Repair of Errors in Elicitations. Medical Decision Making 23(1), 67-75.
• Llewellyn-Thomas, H., H. Sutherland, R. Tibshirani, A. Ciampi, J. Till, and N. Boyd (1982), The Measurement of Patients’ Values in Medicine. Medical Decision Making 2(4), 449-462.
• Luce, R. D. and H. Raiffa (1957), Games and decisions: introduction and critical survey. New York: Wiley.
• Lupu, I. (2006), Calitatea vieţii în sănătate: Definitii şi instrumente de evaluare. Calitatea Vieţii 17(1-2), 73-91.
• Meltzer, D. (1997), Accounting for future costs in medical cost-effectiveness analysis. Journal of Health Economics 16(1), 33-64.
• Mulley, A. G. J. (1989), Assessing patients’ utilities: Can the ends justify the means? Medical Decision Making 27 (3, suppliment), 269-281.
• Revicki, D. A. and R. M. Kaplan (1993), Relationship between psychometric and utility-based approaches to the measurement of health-related quality of life. Quality of Life Research 2(6), 477-487.
• Rogerson, R. J. (1999), Quality of Life and City Competitiveness. Urban Studies 36(5), 969-985.
• Schwand, C., R. Vetschera, and L. Wakolbinger (2010), The influence of probabilities on the response mode bias in utility elicitation. Theory and Decision 69, 395-416. 10.1007/s11238-010-9193-8.
• Sinescu, I., M. A. Manu, M. Harza, B. Serbanescu, B. Stefan, V. Cerempei, C. Baston, D. Tacu, E. Kerezsy, C. Bucsa, I. Constantinescu, L. Domnisor, E. Burchiu, R. Manu, and O. Palea (2008), Studiul comparativ al calitatii vietii donatorilor de rinichi (tineri / varstnici si inruditi / neinruditi) folosind testul “sf-36 health survey”. Revista Română de Urologie (3), 1-9.
• Smidts, A. (1997), The relationship between risk attitude and strength of preferences: A test of intrinsic risk attitude. Management Science 43(3), 357-370.
• Stiglitz, J. E., A. Sen, and J.-P. Fitoussi (2009), Report by the Commission on the Measurement of Economic Performance and Social Progress.
• Tazebay, I., M. Somuncu, and N. Akpinar (2010), A quantitative assessment for quality of life : The case of metropolitan Ankara, Turkey. Journal of Agricultural Research 5(12), 1360-1372.
• Torrance, G. W. (1986), Measurement of health state utilities for economic appraisal. Journal of health economics 5(1), 1-30.
• Torrance, G. W. (1987), Utility approach to measuring health-related quality of life. Journal of chronic diseases 40(6), 593-603.
• Torrance, G. W. and D. H. Feeny (1989), Utilities and Quality-Adjusted Life Years. International Journal of Technology Assessment in Health Care 5(4), 559-575.
• Torrance, G. W., W. H. Thomas, and D. L. Sackett (1972), A utility maximization model for evaluation of health care programs. Health Services Research 7(2), 118-133.
• von Neumann, J. and O. Morgenstern (1944), Theory of Games and Economic Behavior. Princeton: Princeton University Press.