Despite considerable progress and achievements in health care over the last century, we still cannot give every ill person as full a treatment as possible. With limited resources, decisions have to be made to determine priorities in the health care system. These decisions should be based on both...

There has been a vigorous dispute about quality adjusted life years (QALYs) and it has been argued that they are an inappropriate measure of patient utility and that a more efficient approach is to measure outcomes in terms of health year equivalents (HYEs). This paper explores the theoretical...

The methodology of valuing health states remains a key issue in the construction of health-related quality of life measures. Different scaling methods appear to yield different sets of valuations, and as yet there is no consensus as to which method is the preferred technique. Many of the...

The need for priority setting in health care systems has forced us to think more carefully about objectives and opportunity costs. If our objective is the maximisation of the health of the community, for this to be an effective guide to action we have to find some practical way of describing and...

QALYs (quality adjusted life years) represent a powerful addition to the range of evaluative techniques for use in assessing the impact of health care. In the past, such benefits have been portrayed in terms of their contribution to life expectancy. The ability to adjust for quality of life is...

This paper explores how medical practice ought to be conducted, in the face of scarcity, if our objective is to maximise the benefits of health. After explaining briefly what the cost-per-QALY criterion means, a series of ethical objections to it are considered one by one. The objectors fall...

The EuroQol measure of health-related quality of life (HRQoL) has many purposes other than the calculation of QALYs, but it is upon that particular use that this paper concentrates. For that purpose a simple generic measure yielding a single index score for each health state is required. The...