Quality+adjusted+life+years+(QALY)+What+is+the+standard+time+trade-off+approach++to+measuring+quality+of+life?+How+can+this+be+applied+in+forensic+economics?


 * Quality Adjusted Life Years (QALY)**


 * What is the standard time trade-off approach to measuring quality of life? How can this be applied in forensic economics?**

QALY is an acronym for quality adjusted life years. There are two components to a QALY and they are the quantity and quality of life. The quantity of life is essentially how long a person is going to live or their life expectancy. This is pretty easy to measure given that people are either alive or they are not. However, the quality of life is a little more difficult to measure because it can include many different aspects of a person’s life and not just the aspects directly concerned with the status of their health. The value generally is between the range of 0 and 1, but the value can be a negative number. This is possible because being alive can actually be worse than being dead depending on a person’s condition.

The QALY is calculated by multiplying the quantity value by the quality value. An example would be that if an individual was expected to live for 6 more years but the quality of life was only valued at 0.4, then the QALY would be 2.4 (6 x 0.4).

When it comes to calculating the quality of life, there are many different methods that can be used. The main methods are standard gamble, time trade-off and the use of rating scales. The method that is going to be looked at here is the time trade-off approach. The time trade-off approach asks people to weigh the value of living with a certain medical condition for life versus having a shorter life without the condition. An example could be someone who needs a kidney transplant. If they do not receive the kidney transplant, their life will be shorter and in a worse state of health than if they had received the kidney, which would result in a longer life and a better state of health.

Now that QALY has been discussed, it is time to see how it can be applied to forensic economics. Forensic economics is the application of economic theories to courtroom procedures and debates. In other words, it is economics providing a defense in a court of law. An example of this could easily be found in the insurance arena. Say an insurance company refused to pay for a certain procedure for a person because they said that the procedure was not necessary. A health professional could be brought in to give a life expectancy of the person with and without the procedure. However, this is only so useful. So in addition to the health professional, an economist could be brought in to place values on the quality of life the person would experience with and without the procedure and then monetize those values. When dollar amounts are attached to the comparison of the effects of the procedure on the individual’s life then the defense becomes much more solid.


 * Problems:**

1. A man is 38 years old and lives in Indianapolis, Indiana. He just got diagnosed with a heart condition and his doctor is projecting that his life expectancy is now 43 years. Also his quality of life is now projected at being at a 0.4 level given that no procedure is done to improve his heart condition. What is his QALY for the next 5 years?

Quantity of life = 5 years Quality of life = 0.4 QALY --> 5 years x 0.4 = 2.0 years

2. Given the information from the previous question, what would be the difference in the QALY for the man if he did have a procedure done that would increase his life expectancy to 55 years and the quality of life to 0.8?

Quantity of life = 17 years Quality of life = 0.8 QALY2 --> 17 x 0.8 = 13.6 years QALY2 - QALY1 --> 13.6 - 2.0 = 11.6 years

3. Can a person have a negative value for their quality of life? Why?

Yes. A person can have a negative value of life because their state of health could actually be so bad that being alive is actually worse than being dead.

4. What is the time trade-off approach to measuring the QALY?

The time trade-off approach asks people to weigh the value of living with a certain medical condition for life versus having shorter lives without the condition.


 * Sources:**

http://www.accessmylibrary.com/coms2/summary_0286-28755780_ITM http://www.bmj.com/cgi/content/full/320/7243/1156 http://www.jr2.ox.ac.uk/bandolier/booth/glossary/QALY.html