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    QALY Presentation

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    Paul Proctor
    The document discusses how insurance companies use Quality-Adjusted Life Years (QALYs) to evaluate medical procedures. A QALY is a numerical value calculated based on length of life and quality of life gained from a procedure. Insurance companies use QALYs to determine what treatments they will cover and their cost-effectiveness. While QALYs provide a standard for comparison, they also reduce human life to a single metric and do not consider personal values placed on life.

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    QALY Presentation

    Uploaded by

    Paul Proctor
    58 views9 pages
    The document discusses how insurance companies use Quality-Adjusted Life Years (QALYs) to evaluate medical procedures. A QALY is a numerical value calculated based on length of life and quality of life gained from a procedure. Insurance companies use QALYs to determine what treatments they will cover and their cost-effectiveness. While QALYs provide a standard for comparison, they also reduce human life to a single metric and do not consider personal values placed on life.

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    The document discusses how insurance companies use Quality-Adjusted Life Years (QALYs) to evaluate medical procedures. A QALY is a numerical value calculated based on length of life and quality of life gained from a procedure. Insurance companies use QALYs to determine what treatments they will cover and their cost-effectiveness. While QALYs provide a standard for comparison, they also reduce human life to a single metric and do not consider personal values placed on life.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    58 views9 pages

    QALY Presentation

    Uploaded by

    Paul Proctor
    The document discusses how insurance companies use Quality-Adjusted Life Years (QALYs) to evaluate medical procedures. A QALY is a numerical value calculated based on length of life and quality of life gained from a procedure. Insurance companies use QALYs to determine what treatments they will cover and their cost-effectiveness. While QALYs provide a standard for comparison, they also reduce human life to a single metric and do not consider personal values placed on life.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 9

    QUALITY-ADJUSTED LIFE YEARS (QALY)

    HOW INSURANCE COMPANIES PUT A PRICE TAG ON LIFE


    THE AMERICAN HEALTHCARE SYSTEM: AN OVERVIEW

     3 party system
     Patients, payers (Insurance companies),
    and providers (Hospitals)
     Patients pay monthly fees, or premiums,
    to be covered by insurance
     In turn, when patients pay for care,
    insurers cover a portion of the cost
     A system is required to decide what
    procedures insurance companies cover
     To avoid paying for overly-expensive
    procedures with little benefit
     Keeps monthly premiums low
    DEFINING THE QALY

     A QALY is a numerical representation of the benefit of any given healthcare procedure


     The benefits of any medical procedure are twofold
     Improvement in length of life
     Improvement in quality of life

     The QALY index is calculated based on these two parameters


     QALYs are used by insurance companies to make cost-benefit analysis of medical
    procedures
     This determines what procedures will be covered by the insurer
     How much is 1 day worth? 1 year? In what condition?
    CALCULATING THE QALY INDEX

     To calculated the QALY index of any given

    procedure, implement the following equation:

     Length of life
     Measured in years

     Quality

      of Life
     Measured on a scale from 0-1
     1=perfect health, 0=dead
    EXAMPLE: BYPASS SURGERY

     A ”bypass” is a kind of heart surgery


     “bypasses” blocked arteries in the heart
     Triple bypass addresses 3 different blocked
    arteries, quadruple bypass addresses 4, etc.
     To calculate the QALY index of quadruple
    bypass surgery…
     Length of life: 15 more years
     Quality of life: .8
     QALY Index=15*.8=12 QALYs

     Insurance companies are often willing to


    cover this procedure
    EXAMPLE: CHEMOTHERAPY FOR STAGE 4 SPINAL CANCER

     Stage 4 spinal cancer is, effectively, a death sentence


     Stage 4: the final, most damaging stage of cancer
     Chemotherapy: chemical therapy used to kill cancerous cells
     Extremely significant, life altering side effects

     Quality of life with chemotherapy greatly decreases

     QALY index calculation: low outcomes in both quality and length


    of life
     Length of life: benefit of 3 years
     Quality of life: .3
     QALY index: 3*.3=.9 QALYs
    THE PROBLEMS WITH THE QALY INDEX

     Limitations
     Manipulation of the formula
     Old drugs vs new drugs

     May not capture the value of life effectively


     Due to the subjectivity of the value of life: prioritizing quality over quantity, visa-versa

     Morally ambiguous
     Quantifies the value of human life according to a single rigid standard
     Insensitive to personal/religious world views which place unique value on life
    A CASE FOR THE QALY INDEX

     Quantifies disease burden for rational decision making


     An essential part of deciding on what treatments to encourage
     Gives valuable information on cost-effectiveness and expectations for post-procedure life

     Terrible diseases require terrible cures


     QALYs are an indicator
     Sometimes the cure just isn’t worth it
    WORKS CITED

    Prieto, L.; Sacristán, J. A. Problems and solutions in calculating quality-adjusted life years
    (QALYs). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC317370/ (accessed Dec 17, 2019).
    Soffen, K.; Washington Post. Single-payer would drastically change American health care;
    here's how it works. https://www.inquirer.com/philly/health/health-cents/single-payer-would-
    drastically-change-american-health-care-heres-how-it-works-20171018.html (accessed Dec
    17, 2019).
    Coronary bypass surgery. https://www.mayoclinic.org/tests-procedures/coronary-bypass-
    surgery/about/pac-20384589 (accessed Dec 17, 2019).
    Spinal Tumor Diagnosis. https://www.mdanderson.org/cancer-types/spinal-tumors/spinal-
    tumor-diagnosis.html (accessed Dec 17, 2019).

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