Portal de Periódicos da CAPES

The New Myth

2008; Adis, Springer Healthcare; Volume: 26; Issue: 1 Linguagem: Inglês

10.2165/00019053-200826010-00001

1179-2027

Werner Brouwer, Job van Exel, Rachel Baker, Cam Donaldson,

Retirement, Disability, and Employment

The New Myth end result of the Economic Evaluation: the Ratio.The Ratio basically indicates how much wealth oneThe Social Value of the QALY needs to sacrifice on the altar of the healthcare Throughout history there have always been peosystem in order to obtain one additional QALY.The ple who are susceptible to myths and have tried to ritual ends by presenting the Ratio to all tribe memfind the unfindable, whether it be the Holy Grail bers and others, mainly through an obscure system providing eternal life for its finder, the alchemic of holy books, called Journals, some of which are formula turning lead into gold, Bigfoot or the pot of more holy than others.gold at the end of the rainbow.These myths come in For a long time, the tribe of Believers professed different forms; some are clearly placed in a religthat The Ratio was all they needed, the highest ious or metaphysical context (e.g. the Holy Grail), knowledge, all Ratios being brought to a high altar, while others are marketed with an earthly and scienor table. 3 The Ratios, they repeated like a mantra, tific aura (e.g. the hairs of Bigfoot).help us to maximise health effects from a given At present, a new myth is seeking its way into the healthcare budget!But, as the tribe became more world.It has sought a particularly receptive bunch of influential, it became more apparent that the Ratio people to nestle in, called health economists.We could not solve all problems.At tribal meetings will call them 'Believers'.The Believers form a (preferably in sunny places), the Ratio was questionrelatively friendly tribe, although some theoretical ed as the sole source of information. 4Some tribal quarrels between tribe members have been reported.members, for instance, argued that the Ratio itself Their sole goal in life is to help societies in their does not indicate whether the healthcare budget struggle with the optimal allocation of resources in should be raised or whether 'old care' should be the healthcare sector. 1 To that end, the Believers replaced with 'new care' within the existing budget.have designed a friendly instrument that they nor-What was needed was a way to interpret the Ratio in mally refer to as 'Economic Evaluation'.The ritual a broader context, the tribe's creed started to read. of the Economic Evaluation involves assessing the Something new was needed, something big, someincremental costs and health gains of one healthcare thing of mythical proportions; something they called intervention compared with another. 2 The incrementhe 'Social Value of the QALY', codename: λ.Tribe tal health gain, which is believed to be the maximembers found ancient texts in sacred books (e.g.mand of the healthcare sector, is normally dressed Boadway and Bruce [3] ) that already pointed to the up in the ritual to take the shape of a quality-adjusted relationship between the Ratio and this mythical λ. life-year -friends call her QALY.After the incre-And so the quest began … mental costs and effects are assessed, the ritual In order to reach the intended readership, we will involves some straightforward or more complex statistical magic, often performed by specialised priests use tribal language from now on.1 The very brave sometimes even attempt to assist in the optimal allocation of resources across (public) sectors. 2 Although there is some international variation (e.g.especially slight differences in terms of which sacrifices -called costs -should be considered in the ritual and how), the basic ritual is the same in all branches of the tribe.3 Although it needs to be noted that a small group of persistent dissidents within the tribe have questioned the Ratio as highest knowledge, and have advocated other convictions regarding how to come to optimal allocations (for example, see Gafni and Birch [1] ). 4 For example, the session on the social value of a QALY during the iHEA conference in Copenhagen.