{"id":3051,"date":"2016-07-28T10:02:29","date_gmt":"2016-07-28T09:02:29","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3051"},"modified":"2016-07-28T10:02:29","modified_gmt":"2016-07-28T09:02:29","slug":"individualised-and-personalised-qalys-in-exceptional-treatment-decisions","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/07\/28\/individualised-and-personalised-qalys-in-exceptional-treatment-decisions\/","title":{"rendered":"Individualised and Personalised QALYs in Exceptional Treatment Decisions"},"content":{"rendered":"

Guest Post by\u00a0Warwick Heale<\/strong><\/em><\/p>\n

When NICE decides whether to make a treatment available on the NHS it considers both clinical effectiveness and cost effectiveness.\u00a0 Cost effectiveness is based on population-level QALY data, as is appropriate for a population-level policy.\u00a0 However, this can cause problems for exceptional individual patients.<\/p>\n

When a doctor wants to offer an individual patient a treatment that has been deemed by NICE not to be cost-effective, the doctor can make an Individual Funding Request (IFR) to NHS England or a Clinical Commissioning Group.\u00a0 The doctor must convince the IFR Panel that the patient is exceptional and that it is worth spending the money on this patient, leaving less to be spent on others.\u00a0 The Panel\u2019s presumption, based on the population-level data, is that the treatment will not be cost effective, and this stacks the cards against the individual patient, however extreme the patient or their condition may be compared to the population average.<\/p>\n

One solution to this might be to consider individualised cost or response (individualised QALYs) or personalised valuations of health states (personalised QALYs).\u00a0 Applying these concepts might protect the patient from a treatment being refused even if he or she is markedly different from the population average.\u00a0 In doing this, we would actually promote utility and effective use of resources which is one aim of the IFR process, but one which I think it fails to achieve as effectively as it might.<\/p>\n

Consideration of personalised QALYs also offers a justification for offering a Jehovah\u2019s Witness a more costly alternative to blood transfusion, on the basis that this would actually maximise the utility we gain from our limited resources \u2013 in contradiction to the more obvious view that this would compromise utility.\u00a0 Furthermore, in doing this we don\u2019t need to give any special status to religious considerations \u2013 the Jehovah’s Witness, the patient of a different faith and the\u00a0atheist should all be subject to the same principles of personalised QALYs.\u00a0 Personalised QALYs also allow us to think about patient choice alongside utility rather than as independent principles.<\/p>\n

Read the full paper here<\/a><\/span>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Guest Post by\u00a0Warwick Heale When NICE decides whether to make a treatment available on the NHS it considers both clinical effectiveness and cost effectiveness.\u00a0 Cost effectiveness is based on population-level QALY data, as is appropriate for a population-level policy.\u00a0 However, this can cause problems for exceptional individual patients. When a doctor wants to offer an […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[968,2153,443,1544],"tags":[],"class_list":["post-3051","post","type-post","status-publish","format-standard","hentry","category-clinical-ethics","category-guest-post","category-jme","category-the-nhs"],"yoast_head":"\nIndividualised and Personalised QALYs in Exceptional Treatment Decisions - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/07\/28\/individualised-and-personalised-qalys-in-exceptional-treatment-decisions\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Individualised and Personalised QALYs in Exceptional Treatment Decisions - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"Guest Post by\u00a0Warwick Heale When NICE decides whether to make a treatment available on the NHS it considers both clinical effectiveness and cost effectiveness.\u00a0 Cost effectiveness is based on population-level QALY data, as is appropriate for a population-level policy.\u00a0 However, this can cause problems for exceptional individual patients. 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