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Comment by platz | Hacker News Reader

By your logic any procedure that prevents death is cost adjusted by how many years the patient lives. It 'proves too much'. If I'm 30 and I suffer a knife wound then you could charge any amount to prevent my death, justifying by averaging over 40 years. All kinds of medical intervention may be necessary to prevent death, but that doesn't mean they shouldn't be affordable.

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I think the point is to set an upper bound on how much a government ought to be willing to pay for a given procedure, and to compute that upper bound by counting QALYs and multiplying by their official dollar value.

For example:

Value of stitching knife wound: (40 QALYs) * (30,000 GBP/QALY) = 1.2M GBP

Cost of stitching knife wound: (let's say) 1000 GBP

Decision process:

Is the cost less than the value? 1000 < 1.2M, so yes. Therefore, pay for the procedure.

Whereas:

Value of expensive cancer procedure on 70-year-old: Let's say 5 QALYs just to make up something, taking into account expected lifespan and QOL and chance of remission, etc, times the same 30k GBP, = 150k GBP.

Cost of procedure: 1M GBP

Decision process:

Is the cost less than the value? 1M > 150k, so no. Therefore, don't pay for the procedure.

I, and a lot of other people, don’t like this thought process. We are quite bad at estimating how much someone has left to live. We are worse at estimating the quality of the life someone will experience. And then that someone may be single, with no family, or have 3 kids still in elementary school. Are you going to consider the quality of life of their dependents. What if that person is about to solve the nuclear fusion, or the Riemann hypothesis, would you pay 1M to keep them alive one more year? Would you let them die after their work is done?

I think it's reasonable to not be totally comfortable with that. But can you think of a better system?

To address the important scientist point you made, I could see it being in the interest of society to give some people extra special care (e.g. the US president gets top care), although mostly it's hard to value what should qualify someone, as you say. I think in some heartstrings cases we see GoFundMe's and such filling the gap; perhaps that's the proper role for charity in the system?

I believe these assessments are made on a general rather than an individual basis. It's not a question of whether treatment should be approved for an individual patient ("death panels") but whether a treatment is sufficiently effective for its cost to be made available.

I was trying to correct what seemed to me to be a miscommunication (I thought my parent post misunderstood something about what GP comment was saying). I wasn't trying to endorse or condemn any particular system for evaluating procedures, in my earlier comment; just pointing out that the system wasn't flawed on its own terms in such an obvious way.

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