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Paradigm Lost: a conceptual and empirical obituary chronicling the demise of cardinal utility measurement

Wednesday 13 January 2010, 12.00PM

Speaker(s): Paul Kind. Professor of Economics, Centre for Health Economics, University of York

Abstract

Despite a range of alternatives, the choice of quality-adjustment factor recognised by health economics orthodoxy and required by health regulatory agencies, dictates that the "Q" in QALY should be a utility measure. This requirement has encouraged a state of chaos in which multiple methods for eliciting utilities are permitted and in which no test of their performance has been documented. Religious zeal appears to have replaced scientific rigour. This paper reflects the status of utility measurement as applied in QALY calculations and conclusively demonstrates its fallibility.

The paper comprises two parts, the first of which rehearses basic measurement requirements of any stable, viable metric for use as a quality-adjustment scalar and deals with the impossibility of permitting mutually incompatible utility elicitation procedures. It concludes with a novel test of uniqueness that can be applied to competing sets of “utility” weights. Some of this material has been previously presented . The second part is based on new empirical evidence based on analysis of data from the MVH in which both TTO and VAS ratings were used to calibrate EQ-5D. Analysis compares ordinal preferences revealed through VAS rating on a within-respondent basis with the ordering of states inferred by “utilities” elicited using TTO.

26% of respondents assigned a “utility” of 1.0 (full health) to 3 or more health states with differing degrees of dysfunction. On the basis of TTO “utilities” more than 40% of respondents fail to distinguish between full health and the 5 mildest health states. The demonstrable frailty of “utility” elicitation methods is well-known. Research scientists in general and health economists in particular should be wary of encouraging others to accept QALY metrics of this type. The continued requirement for “utility” measures in social decision-making compromises both the science of preference measurement and the scientists who tolerate its misuse.

Location: ARRC Auditorium

Who to contact

For more information on these seminars, contact:

Adriana Castelli 
Tel: +44 (0)1904 321462
Eamil: ac52@york.ac.uk  

CHE Seminar Programme

  • Thursday, 2nd December  
    Hans Severens, Professor of Evaluation in Health Care at Erasmus University, Rotterdam, Netherlands
  • Monday, 10th January
    Hugh Gravelle, Professor of Health Economics, Centre for Health Economics, University of York
  • Thursday, 3rd March
    Alistair McGuire, Professor, Department of Social Policy & LSE Health, London School of Economics