Can Life Expectancy and QALYs Be Improved by a Framework for Deciding Whether to Apply Clinical Guidelines to Patients With Severe Comorbid Disease?

R. Scott Braithwaite

Medical Decision Making, 2011, vol. 31, issue 4, 582-595

Abstract: Background: Guidelines with short-term harms and long-term benefits are often applied to chronically ill patients who may not benefit. The payoff time framework has been proposed (i.e., do not apply a guideline if a patient’s life expectancy (LE) is shorter than when a guideline’s cumulative incremental benefits first exceed its cumulative incremental harms), but its health impact is unclear. Objective: To investigate whether the payoff time framework improves LE and/or quality-adjusted life-years (QALY) for chronically ill patients. Methods: I evaluate impact of the payoff time framework on LE and QALYs, assuming (1) high and constant background mortality rate from chronic illness (≥ 10% per year), (2) immediate guideline-related harm with probability 0.15 per year (corresponding to LE 0.11 per year (corresponding to LE

Keywords: geriatric medicine; internal medicine; performance measurement (search for similar items in EconPapers)
Date: 2011
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Citations: View citations in EconPapers (1)

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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:31:y:2011:i:4:p:582-595

DOI: 10.1177/0272989X10386117

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