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National Center for Chronic Disease Prevention and Health Promotion
Chronic Disease Prevention
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National Center for Chronic Disease Prevention and Health Promotion Chronic Disease Prevention Home | Contact Us |
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CENTERS FOR
DISEASE CONTROL AND PREVENTION
Using Quality of Life to Measure a Program’s Effectiveness and Value Your chronic disease program is very effective. People are living years longer as a result of your efforts. So what?
And even if people are living better and longer, are the benefits of your program worth the costs? asked Ping Zhang, PhD, a CDC health economist. One way to answer these questions is to measure how a program affects both length of life and quality of life. Measures that take length and quality of life into account are known as aggregate or summary measures of health. Quality-adjusted life years (QALYs) are one type of aggregate measure used in economic evaluations (see Measuring Quality of Life in the World, Nation, States, and Local Areas.) “The concept of QALYs is fairly straightforward when we think about what chronic diseases do — they shorten your life and make it not as good as it would have been had you not developed the chronic disease,” noted Dr. Engelgau. “With QALYs, you’re trying to quantify that. For example, diabetes can cause blindness, kidney failure, and amputation. Living years with these conditions tends to make the quality of those years less when compared with someone without these conditions.” Researchers can use measures such as QALYs to estimate how much longer people could live and how much better their lives would be during their remaining years with a health intervention as opposed to without (see graph). Health economists can also calculate the cost per QALY gained to measure a program’s cost-effectiveness. Two programs can then be compared to determine which program adds more QALYs to a person’s life for the same amount of money. Preference-Based
Measures “Preference-based utility scores are developed by going to the general population and asking people how undesirable it is to have certain conditions,” Dr. Engelgau explained. Thus, preference-based scores reflect how individuals rate the magnitude of the problem. “One person might say being blind is devastating, but another might say it’s not that bad. Maybe they’ve learned to adapt.” States probably don’t have the resources to conduct primary research to elicit preferences for health states, noted Vilma G. Carande-Kulis, PhD, a CDC health economist. One option, she said, would be for the federal government to work with communities to elicit preferences through grants and contracts. The states could then coordinate the research. “CDC could lead an initiative to build surveys on the Web,” she suggested. “There are pretty good published results comparing how representative Web, mail, and telephone surveys are.” Economics Just Part of the Equation
Equity and Social Responsibility
“On the flip side, in high-risk populations, such as underserved and low-income people with high risks for chronic disease, we don’t know about the economics of treating these populations,” Dr. Engelgau noted. But on the basis of what other economic evaluations have found, interventions targeting these people might be more cost-effective than interventions targeting people not at high risk “because they’re in such bad health already,” he said. As medical technologies advance, more procedures that vastly improve some people’s quality of life—for example, hip replacement surgery and certain cardiovascular disease treatments—will become more available, but these procedures will also be very costly, Dr. Zhang explained. “Society can’t afford for everybody to have these procedures,” he said. “Economic evaluations of these technologies can help us to determine which procedure gives a better value for our money and should be adopted first at the population level.” Feasibility
For example, a county might raise taxes to build more sidewalks and encourage people to walk outdoors. “But you might also have cheap gas and tax breaks to developers, encouraging the building of subdivisions farther and farther out,” away from the parks and shops, Dr. Carande- Kulis explained. “So you’re disconnecting people in the community. They have the sidewalks, but where are they going to walk to?” Economic consequences also must be considered, noted Steven M. Teutsch, MD, MPH, executive director of outcomes research and management for Merck & Co. in West Point, Pennsylvania. “For example, it’s not expensive to pass a clean air law. It’s cheap for the state, but it imposes huge costs on others,” he pointed out. In the private sector, most businesses expect a quality-of-life program’s costs to at least be matched by its benefits. “Businesses want to know: What does it mean for them?” Dr. Teutsch said. Will employees have fewer migraines at work because of the program? Will they be more productive on the job? Will insurance claims decline? Another important question for businesses to ask is this: Will employees take advantage of the program? “No company will put a treadmill in every employee’s office,” Dr. Carande-Kulis pointed out. “It’s not feasible. Some folks might be using them to hang their jackets on and never use them to exercise.” Getting the Most Value
Quality-Adjusted Life Years (QALYs) Gained from a Program
QALYs allow researchers to measure the gains in both years and quality of life resulting from a program. Rather than conduct their own cost-effectiveness studies, many states rely on expert guidance from sources such as the independent Task Force on Community Preventive Services. The task force conducts systematic reviews of the effectiveness and economic efficiency of various population-based interventions and makes recommendations based on effectiveness. Dr. Teutsch, who is a member of the task force, suggested that health departments learn about the basic questions that are asked in these studies:
QALYs are an important measure that can be used to answer these questions. Whether your intervention aims to change people’s behaviors, the environment, or systems (such as health care, education, or transportation), the health effects can be assessed in terms of QALYs. “For instance, we now have evidence that diet and exercise can lower the risk of developing diabetes among people who are at high risk,” Dr. Engelgau explained. “The next questions are how much does it cost? Is it too much? Is it a good investment?” he said. “The cost per QALY will tell you if it’s a good investment or not.” Dr. Zhang and Dr. Engelgau encourage health department staff to learn more about QALYs and the various other aggregate measures used to assess health-related quality of life. “Take time to understand the concept of an aggregate outcome,” advised Dr. Engelgau. “It provides the answer to the question ‘So what?’” Suggested Reading Dasbach EJ, Teutsch SM. Quality of life. In: Haddix AC, Teutsch SM, Corso PS, editors. Prevention Effectiveness. 2nd edition. New York: Oxford University Press, 2003;p. 77–91. Gold MR, Siegel JE, Russell LB, Weinstein MC, editors. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press; 1996. Drummond M, McGuire A, editors. Economic Evaluation in Health Care. Merging Theory with Practice. New York: Oxford University Press; 2000. Task Force on Community Preventive Services. Guide to Community Preventive Services. Available at http://www.thecommunityguide.org/methods/default.htm*
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Privacy
Policy | Accessibility This page last reviewed August 10, 2004 United
States Department of Health and Human Services |
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When measuring the value
of a program, a better question might be, “Are people living better and
longer?” said Michael M. Engelgau, MD, a CDC medical epidemiologist. For
instance, is your program helping people manage their pain better? Is it
allowing them to remain active and independent? 
