Integration of Quality of Life and Survival for Comparative Risk/Outcome Assessment in Healthcare Industry
Survival and quality of life (QOL) are two key measurements for outcome evaluation in health care services. While the former can be objectively determined, the latter can only be obtained from subjective reports of the patients with specific health condit
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Springer Science+Business Media LLC 2010 (USA)
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Integration of Quality of Life and Survival
Abstract: Survival and quality of life (QOL) are two key measurements for outcome evaluation in health care services. While the former can be objectively determined, the latter can only be obtained from subjective reports of the patients with specific health conditions. Considering these two outcome functions together can derive a universal equation in healthcare evaluation with quality-adjusted life year (QALY) as the common unit, when the QOL is measured in utility or preference. Because many patient cohorts are only followed for a limited period of time with a high censored rate or above 50%, we have developed a Monte Carlo method that borrows information from age- and sex- matched general population for extrapolation of survival function to life time. By doing so, we are able to simultaneously quantify the years of life expectancy loss for a specific health condition. When the QOL function is measured by psychometric instruments, the resulted score-time can be used on outcome evaluation on clinical medicine; when the QOL function is replaced by medical cost reimbursed by the National Health Insurance, we can obtain the lifetime financial burden for a specific health condition; both developments can be used for comparative outcome assessment in health care services. Empirical examples are provided as a demonstration of feasibility. The objective of this chapter is to introduce a novel method of integration between survival and quality of life functions and illustrate how it can be directly applied for comparative health risk and clinical outcome assessments. We shall begin with the original concept of quantifying the burden of diseases, followed by deriving the equation for health, application of such methods for health risk assessment in three different settings, extension of the QOL measurement to psychometry and estimation of lifetime medical costs. List of Abbreviations: AIDS, acquired immunodeficiency syndrome; DALY, disabilityadjusted life year; EQ-5D, euroQOL 5D; HCC, hepatocellular carcinoma; HIV, human immunodeficiency virus; NHI, National Health Insurance; NIS, National Insurance System; QALE, quality-adjusted life expectancy; QALM, quality-adjusted life month; QALY, quality-adjusted life year; QAS, quality-adjusted survival; QAST, quality-adjusted survival time; QOL, quality of life; RME, reasonable maximum exposure; SG, standard gamble; WHOQOL, World Health Organization quality of life
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Quantification of Burdens of Diseases
Beginning in the late 1960s, the integration of QOL and survival for quantification of healthy life expectancy was first proposed for the evaluation of healthcare of chronic renal disease (Klarman et al., 1968). It has been developed into a summary measure for population health (Murray et al., 2002) in the later several decades with quality-adjusted life year (QALY) and/or disability-adjusted life year (DALY) as the common unit (Ezzati et al., 2004) for international compa
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