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Quality of of Health Ratings

Only complete this step for the primary outputs or outcomes affecting your health care condition.

• Using the following scale of -100 to 100, and the relative degree of changes, rate how each of the five dimension of health listed below got better or worse AS A RESULT OF the health care treatment you received. Ratings that are considered not important, not known, or not applicable, should be rated 0. Use whole numbers such as -55 or 25.
• -100 = this dimension of health quality got completely worse
• -75 = this dimension of health quality got a lot worse
• -50 = this dimension of health quality got moderately worse
• -25 = this dimension of health quality got a little worse
• 0 = do not include this dimension of health quality in the rating
• 25 = this dimension of health quality got a little better
• 50 = this dimension of health quality got moderately better
• 75 = this dimension of health quality got a lot better
• 100 = this dimension of health quality got completely better

Physical Health.

• This rating includes:
• the degree and frequency of pain and discomfort;
• the performance of daily living activities, such as dressing, washing, shopping, cooking, and driving;
• the ability to walk around, exercise, and move about;
• the ability to see, hear, talk, and communicate;
• the ability to relax and sleep.

Emotional Health.

• This rating includes:
• the degree and frequency of anxiety, sadness, depression, and anger;
• the degree of happiness and peace of mind;
• the ability to cope with life;
• the level of energy;
• the degree of spirituality.

Social Health.

• This rating includes:
• the way relations with relatives and friends changed;
• the way burdens on persons who helped with this health care condition changed (i.e. did caregivers have to spend less time taking care of you?);
• the degree of participation in social and community activities;
• the degree to which intimate relationships, including sexual relations, got better or worse;
• the way memory and the ability to learn new things changed.

Economic Health.

• This rating includes:
• the degree of participation in leisure actities (such as golf or travel);
• the ability to engage in productive work (go back to a job or work as a volunteer);
• the way income and wealth changed (amount paid out of pocket for the health care, reductions in savings accounts);
• the amount of time saved (i.e. visiting offices, travelling for health care);
• the amount of productive knowledge gained (about medicines to take, life style changes needed, and other health-related knowledge).

Quality of of Health Care Delivery Ratings.

• Using the following scale of -100 to 100, and the relative degree of changes, rate the quality of the health care you received DURING THE TREATMENT that resulted in this health care outcome. Ratings that are considered not important, not known, or not applicable, should be rated 0. Use whole numbers such as -55 or 25.
• -100 = this dimension of health care delivery was absolutely terrible
• -75 = this dimension of health care delivery was very bad
• -50 = this dimension of health care delivery was moderately bad
• -25 = this dimension of health care delivery was a little bad
• 0 = do not include this dimension of health care delivery in the rating
• 25 = this dimension of health care delivery was a little good
• 50 = this dimension of health care delivery was moderately good
• 75 = this dimension of health care delivery was very good
• 100 = this dimension of health care delivery was absolutely excellent

Health Care Delivery.

• This rating includes:
• the satisfaction with the health care treatment received;
• the appropriateness of the health care treatment received;
• the competency of the health care providers who delivered this health care treatment;
• the accessability of the health care providers who delivered this health care treatment;
• the timeliness of the health care treatment;
• the fairness in the way the health care recipient was treated.

Health Quality Benefits

2. 'Before Treatment' Health-Related Quality of Life Ratings.

• Given the changes in the five dimensions of health quality completed in the last step, use the following scale to rate the state of your overall health BEFORE you received this treatment for this health outcome. Use whole numbers such as -20 or 45.
• -25 = this health condition caused the overall quality of my health to be worse than death
• 0 = this health condition caused the overall quality of my health to be equivalent to death (or death actually occurred)
• 25 = this health condition caused the overall quality of my health to be poor
• 50 = this health condition caused the overall quality of my health to be good
• 75 = this health condition caused the overall quality of my health to be excellent
• 100 = this health condition caused the overall quality of my health to be perfect

2. 'After Treatment' Health-Related Quality of Life Ratings.

• Given the changes in the five dimensions of health quality completed in the last step, use the following scale to rate the state of your overall health AFTER you received this treatment for this health outcome.
• -25 = this health outcome caused the overall quality of my health to be worse than death
• 0 = this health outcome caused the overall quality of my health to be equivalent to death (or death actually occurred)
• 25 = this health outcome caused the overall quality of my health to be poor
• 50 = this health outcome caused the overall quality of my health to be good
• 75 = this health outcome caused the overall quality of my health to be excellent
• 100 = this health outcome caused the overall quality of my health to be perfect

Step 1

• Step 1. Use Same Calculator Pack In Descendants?: True to insert or update this same calculator in children.
• Step 1. Overwrite Descendants?: True to insert or update all of the attributes of this same calculator in all children. False only updates children attributes that are controlled by the developer of this calculator (i.e. version, stylesheet name, relatedcalculatorstype ...)
• Step 1. What If Tag Name: Instructional videos explaining the use of what-if scenario calculations should be viewed before changing or using this parameter.
• Step 1. Related Calculators Type: When the Use Same Calculator Pack in Descendant is true, uses this value to determine which descendant calculator to update. Inserts a new descendant when no descendant has this same name. Updates the descendant that has this same name.
• Step 1. Real and Nominal Rates: The nominal rate includes inflation while the real rate does not. The QALY will be discounted by the real rate. Note that when this output is added to a budget, the rates chosen in the budget calculator or analyzer can override this rate.

Step 2

• Step 2. Demographics: Fill in the information about the health care recipient.
• Step 2. Output Cost (optional): Total cost of the inputs used to produce this outcome. Should be taken from a related DevTreks cost, or budget, calculator (using the cost perspective used in the calculations).
• Step 2. Benefit Adjustment: How much you are willing to pay to cover #7. Output Cost. Express the value as a percent of the total costs (i.e. 50, 200). Use only whole numbers with no '%' sign. This number is divided by 100 and multiplied by the Output Cost to derive the Adjusted Benefit calculation. It provides a quantitative assessment of benefits and can include indirect, or related, benefits. Documentation should be included in the Description.
• Step 2. Output Effects (optional): Supports cost effectiveness analysis by allowing costs to be divided by this output effect, such as 'strokes averted', 'infections reduced', or 'deaths avoided', per dollar cost.

• Benefit Perspective: Some economists believe that the 'ideal' entity completing the benefit estimate is a 'perfect' insurance provider who acts as a 'perfect' agent for the recipient (who pays out all payments collected as benefits and is not motivated by making profits). In practice, the perspective can be chosen based on the requirements of the economic evaluation. Costs and Benefits should use the same perspective.
• Before Treatment Comparator: Many health care organizations recommend using 'routine care' as the 'before treatment' comparator. In practice, the comparator can be chosen based on the requirements of the economic evaluation. Please try to keep the comparators consistent within a network.

Step 3

• Step 3. Ratings: Health care economists (Sinnott, 2007) note that new outcome-based (or specific disease) HRQol instruments with new scoring systems may be appropriate, and provide better results than more generic instruments, when health care preferences are based on specific inputs and outcomes (i.e. on specific diseases). Therefore, this new rating system was developed as one potential instrument. Ratings can be -100 to 100, with only whole numbers acceptable. Ratings that are considered not important, not known, or not applicable, should be rated 0. Efforts should be made to ensure that factors considered as costs (i.e. lost productivity, time savings) should be specifically considered for benefits as well (i.e. considered in the Economic Health Dimension). Other HRQol instruments have demonstrated that instruments with fewer factors can be largely as effective as instruments with a large number of factors. Some governments (England, Ireland) recommend that the 'before treatment' condition (or comparator) should be 'routine care'.
• Step 3. Physical Health Rating: Rates the degree to which the health care recipient's physical health changed as a result of the health care inputs (treatment) used with this health care outcome.
• Step 3. Emotional Health Rating: Rates the degree to which the health care recipient's emotional health changed as a result of the health care inputs (treatment) used with this health care outcome.
• Step 3. Social Health Rating: Rates the degree to which the health care recipient's social health changed as a result of the health care inputs (treatment) used with this health care outcome.
• Step 3. Economic Health Rating: Rates the degree to which the health care recipient's economic health changed as a result of the health care inputs (treatment) used with this health care outcome.
• Step 3. Health Care Delivery Rating: Rates the performance of the health care delivery system used to treat the recipient's health condition and that resulted in this specific outcome (see Access Economics, 2009 and Chandra, 2011).
• Step 3. Will Do Survey: True means that you are willing to complete a more comprensive survey about the benefits and costs of health care. A logical followup survey would include the individual factors within each rating.
• Step 3. Benefit Assessment: Provide an explanation for the ratings made above.

Step 4

• Step 4. Before and After Health-Related Quality of Life Ratings: Rates the 'before and after treatment' health-related quality of life state of the health care recipient. This is the only factor used in the final calculated QALY and allows the previous five health quality dimensions to be weighted differently. The whole number rating system means that 126 health states are possible (-25 to 100). Each health state is a self-weighted blend of the five health care dimensions rated in the previous step. The rating is divided by 100 to derive the final QALY weight and to adapt to the convention of using 0 to 1 health status states.
• Step 4. Before Treatment Health-Related Quality of Life Ratings: Please consider all of the five health quality dimensions included in the previous step. You can place greater importance on some dimensions over other ones. See the 'Before Treatment' Comparator section in the Instructions.
• Step 4. After Treatment Health-Related Quality of Life Ratings: The simplest way to come up with an 'after' rating is to add the average points of the combined five dimension to the 'before' rating. However, you may want to place greater importance on some dimensions over other ones. For example, if the average change in the five dimension is +25, but you place greater weight on a dimension that is higher than 25, you might want to add more than 25 points to the 'before' rating to derive the 'after' rating. You can increase or decrease the rating because of positive or negative interrelationships among the five dimension.
• Step 4. Preference-based health status weights for populations : Many health economists (Sinnott, 2007) recommend that population utility values be used as preference, or QALY, weights and that these values be drawn from representative population samples. Some economists allow that, when this was not possible, the values of individual patients, like this rating system, may be used. Like everything else in DevTreks, the instrument is new and hasn't been tested to meet the validity, feasibility, reliability, and responsiveness criteria needed by HRQol instruments.
• Step 4. Duration in Before Condition: Enter the number of years you expected to live with your health condition if this health care outcome was not achieved. Use decimals to deal with periods less than one year (i.e. 3 months = .25 years). You should obtain this information from a health care professional or reference.
• Step 4. Duration in After Condition: Enter the number of years you expect to live with this health care outcome (in the 'after treatment' state).
• Step 4. Probability of Duration in After Condition: Enter the probability of living with this health care outcome. If the probability is less than 100%, the remainder of the time will be calculated using the 'before treatment' health state. If the probability of living for the full number 'after treatment' years is 90%, enter 90. You should obtain this information from a health care professional or reference.
• Step 4. Time Tradeoff (optional): This question is based on the assumption that you would be willing to live fewer years in the 'after treatment' state of health in order not to have to live more years in the 'before treatment' state of health. For example, some people may prefer to live 10 disease-free years rather than 17 years with a disease (in this case the Time Tradeoff Years = 10, 10 disease-free years means the same to you as 17 disease-laden years). The question is not asking you about the scientific probablilty of these years, it is strictly asking about your preference for living 'illness-free' versus 'illness-borne'. The formula used to derive a QALY weight = time tradeoff years / 'before treatment' years, scaled 0-1 . Optional because some recipients are not willing to give up any time (i.e. handicapped persons).
• Step 4. Equity Multiplier (optional): Existing quality of life ratings have been criticized for not including any consideration for equity (i.e. every QALY is equal to every other QALY). The result is that children's QALY's are identical to elderly persons even though some people consider increases in children's health to have greater overall benefits. This multplier allows an equity adjustment to be included in the final QALY. The multiplier should come from a formal, fully documented, and accepted, QALY-equity multiplier system.
• Step 4. Description: Explanation for the information entered in this step.

• Step 4. Average Benefit Rating: Sum of step 3's ratings divided by the number of nonzero ratings. Ratings of 0 are left out of the calculation.
• Step 4. QALY: The formula used to determine the initial QALY is: QALY = (AfterQOLRating / 100) * AfterYears * DiscountFactor(realrate, afteryears). The next calculation is: QALY = (QALY * (AfterYearsProb / 100)) + (BeforeQALY * ((100 - AfterYearsProb) / 100)). The final calculation is QALY = QALY * (EquityMultiplier / 100)
• Step 4. Time Tradeoff QALY: The formula used to determine this QALY is: TTOQALY = (TimeTradeoffYears / BeforeYears) * AfterYears * DiscountFactor(realrate, afteryears). The final calculation is TTOQALY = TTOQALY * (EquityMultiplier / 100)
• Step 4. Adjusted Benefit: Example: $110 = $100 (inputs costs) * (110% (Benefit Adjustment) / 100)

References

• This calculator needs vetting in the field before it can be fully used to provide health care decision support.
• Access Economics. An improved HTA economic evaluation framework for Australia. A (report for the) Medical Technology Association of Australia. May, 2009.
• J. Brazier, M. Deverill, C. Green, R. Harper A. Booth. A review of the use of health status measures in economic evaluation. Health Technology Assessment 1999; Vol. 3: No. 9
• Amitabh Chandra, Anupam B. Jena, Jonathan S. Skinner. The Pragmatist’s Guide to Comparative Effectiveness Research. NBER Working Paper No. 16990, April 2011, JEL No. H51,I1
• Alan M. Garber. Advances in Cost-Effectiveness Analysis of Health Interventions. Working Paper 7198. National Bureau of Economic Research. June 1999.
• National Institute for Health and Clinical Excellence (NICE, England). Guide to the methods of technology appraisal. June, 2008.
• National Institute for Health and Clinical Excellence (NICE, England). Briefing papers for the update to the Methods Guide (2008 Technology Appraisals Methods Guide), January, 2012
• National Health and Medical Research Council. (NHRMC, Australia) How to compare the costs and benefits: evaluation of the economic evidence. Handbook series on preparing clinical practice guidelines. July 2001
• Franco Sassi. Calculating QALYs, comparing QALY and DALY calculations. Department of Social Policy, The London School of Economics and Political Science, London, UK. Advance Access publication. July, 2006
• Sinnott PL, Joyce VR, Barnett PG. Preference Measurement in Economic Analysis. Guidebook. Menlo Park CA. VA Palo Alto, Health Economics Resource Center; 2007.
• Health Information and Quality Authority (Ireland). Guidelines for the Economic Evaluation of Health Technologies in Ireland. November 2010. Guidelines for the Economic Evaluation of Health Technologies in Ireland. www.hiqa.ie