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We now have more quantity of life (we live longer than ever before), but how’s our quality of life?

That depends.

Quality of life can be partly perception: is the glass half full or half empty? It can also be an objective and measurable experience.

There are a few factors that contribute to our quality of life: freedom, access to resources, the cleanliness of the environment and health.

Health is what we’re most interested in here.

Adjust. For quality.

In economics, ‘Quality-Adjusted Life Years’ (QALYs) are used to measure the combination of health-related quality of life and quantity of life.

In the absence of illness and disability, each year equals one QALY. When illness or disability are present, each year spent living with those conditions equals less than one QALY.

QALYs are used when making decisions about which treatment options provide the most quality of life.

QALYs consider both the costs and benefits of different treatments. Costs can include not just the price tag, but all costs, including things like lost productivity due to inability to work and the time spent by caregivers.

All costs are given a dollar value, because... economics, and so, using this method, we can determine the dollar value of any health improvements that may result from a given treatment.

With me so far?

This post describes how QALYs work and explains why we might want to use them.

Let’s make assumptions

When we use QALYs, we are making a few assumptions:

  1. That health can be measured based on the length of time spent in any given health state.
  2. That there may be states of ill-health that are worse than death, but that generally, death has a value of ‘0’ (no health).
  3. That the absence of disease is a state of perfect health, and that this state has a value of ‘1’. In other words, in the absence of illness or disability, we do not adjust for reduced quality of life: one year of life is one QALY.

How it works

It’s a simple formula: quantity of life (measured in years) combined with quality of life (measured in ‘utilities’) determines how many QALYs a person stands to gain from a particular treatment option.

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Take the Assessment

When the cost of a particular treatment is added to the mathematical mix, we get a cost for each QALY.

So, if treatment X costs $100 per QALY gained and treatment Y costs $1,000 per QALY gained, then we can make a rational decision about which treatment is the most cost-effective. Right?

In economics, the consumer rules

‘Consumer Sovereignty’ is an important concept in economics. It means that each ‘consumer’ (in other words, each person) should be allowed to decide for themselves which products (or in this case, which health outcomes) are the most desirable.

That suits us, because at Biohack U, we’re primarily interested in helping people to take personal responsibility for their own health by setting their own health goals and deciding what they want to do to try to achieve those goals.

Placing value on health

Obviously, better health is more valuable, but how do we decide what value to place on each component of health? What reduction in value do we give to chronic pain compared to depression or loss of vision? What about the variations that can be experienced for each component? How about complete loss of vision compared to partial loss of vision?

Each of us could decide for ourselves and we’d probably come up with different values for each state of illness or disability. An artist might value the ability to see more highly than I do, for example.

Imagine it

Most of us, never having experienced most of these states, would need to use our imagination to place a value on the different components of our health. This can be tricky, because it can be difficult to visualize what it means to be sick or disabled in a particular way if we haven't experienced those states first-hand.

To simplify things, tools have been developed that take the preferences from large population groups and give each state a score based on these preferences. Use of these tools enables a quick assessment of health-related quality of life and also makes it possible to compare one individual to another.

Two assessment tools have been developed: the Health Utilities Index 2 and the Health Utilities Index 3. They are often used together to create a more comprehensive score. I find the explanation of how to calculate a score to be a bit confusing on those pages. For a more straight-forward explanation of scoring, see pages 13-17 of this jolly paper: Preferences for health outcomes and cost-utility analysis.

What’s the point?

This type of economic analysis is usually funded by pharmaceutical companies. A favourable economic analysis enables them to demonstrate that their products are worth investment, despite a hefty price-tag, if they result in improvements to QALYs.

Of course, pharmaceutical companies can afford to fund research. It's a form of marketing.

Lets analyze

I am interested in how we can use these same techniques to demonstrate the value of low-risk healing strategies like the Autoimmune Protocol and the Wahls Protocol.

  • What are the costs of these protocols? Many of us spend more money on our food and more time in the kitchen. We also spend more time on the lifestyle elements of these protocols.
  • What are the benefits? So far most of the evidence about the benefits of healing protocols is anecdotal, meaning that people have experienced healing that has not yet been validated by science. I am comfortable with using anecdotal evidence until the science catches up. Unlike pharmaceutical companies, we have no money to fund research, but that doesn't mean that quality of life can't be measurably improved through the use of healing protocols.

Economic analysis would enable us to compare various treatment options, including healing protocols and pharmaceutical therapies, to evaluate the QALYs that we could expect to gain in each case. In keeping with the concept of consumer sovereignty, individual consumers (like you) could then use this information when making their own health care decisions.

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