AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. April 2011, Volume 13, Number 4.

Ethics Poll

Putting a Price on Life

The Ethics Poll is a snapshot of the opinions of interested readers.

The cost effectiveness of a medical intervention is often expressed in the number of "quality-adjusted life years" (QALYs) the intervention is expected to add to an individual's life. Which of the following best expresses what you know about QALYs?
The National Institute for Health and Clinical Excellence in the U.K. has used a cost per QALY of 30,000 pounds sterling (approximately $48,000) as the benchmark for its publically funded health service. A treatment that costs less than $48,000 per quality-adjusted life year gained will generally be approved, and an intervention costing more will be refused. By this criterion, even treatments with positive clinical outcomes will be unavailable from the National Health Service if their cost per QALY exceeds the threshold. If the U.S. were to apply the cost-per-QALY concept to its publically funded health programs, Medicare and Medicaid, what do you think the benchmark of cost per QALY should be?
Many people have pointed out that rationing of scarce medical resources has always been with us. People have access to medical services they can afford or their insurers (including the U.S. government) have agreed to cover. What do you think is the best way for allocation of scarce medical resources, i.e., rationing decisions, to be made?
Poll results reflect the opinions of visitors to the site who voluntarily answer the poll questions. Those visitors do not represent a random sample of our readers. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.