Are all QALYs equal? Past, present and future of equity weighting

Priority setting in healthcare, including decisions on which health interventions to cover in our collectively funded basic benefits package, is inevitable. Rising expenditures, pressure on budgets, and high prices of new treatment options emphasize that difficult choices need to be make. Ideally, such choices reflect both efficiency and equity considerations. The existing Dutch framework for delineation of the basic benefits package indeed covers both aspects, combining cost-effectiveness information with explicit equity considerations. The latter are based on proportional shortfall, a specific measure of severity of illness that reflects the proportion of otherwise lived health that people lose due to the illness. QALY gains are then valued higher for more severe illnesses.  

While the Dutch framework is internationally advanced, important questions remain about the current equity weights. Is proportional shortfall a good measure? How do we use it in practice? Should patients’ age play a role next to their severity of illness? What evidence is there on societal preferences? How do other countries deal with this issue?

During this symposium, speakers from Norway and the Netherlands will discuss current policies, research findings and ways forward in this important field.

Preliminary programme:

• 13:00     Lunch
• 14:00    Opening - Werner Brouwer (Erasmus University)
• 14:15     Equity considerations in the Netherlands: Past, present, future - Jan van Busschbach (Erasmus MC)
• 14:45     Equity considerations in Norway: Past, present, future - Jan Abel Olsen (University of Tromsø, Norway)
• 15:30     Break
• 16:00     Equity considerations in practice of the Dutch Health Care Institute - Sylvia Vijgen (Dutch Health Care Institute)
• 16:25     Empirical evidence and future directions for equity weighting - Vivian Reckers-Droog (Erasmus University)
• 16:45     Discussion (presenters and audience)

This symposium is linked to the Broader Societal Benefits research program that is financially supported by Pfizer, GlaxoSmithKline, AbbVie, Amgen, and AstraZeneca.