1. Comparing different treatments How can we decide?

2. Which is more important? Treating children who dont grow with growth hormone? Treating people with high blood pressure, who feel perfectly well but are at risk of a heart attack? Treating people with depression, which may prevent them from living a normal life? …

3. Making choices Treating children who dont grow with growth hormone? Treating people with high blood pressure, who feel perfectly well but are at risk of a heart attack? Treating people with depression, which may prevent them from living a normal life? … Why cant we just give everyone whatever treatment they need? Why do we have to make choices at all?

4. How do we compare different treatments? Treating children who dont grow with growth hormone? Treating people with high blood pressure, who feel perfectly well but are at risk of a heart attack? Treating people with depression, which may prevent them from living a normal life? … We measure increase in height. We measure the reduction in cholesterol in the blood. We measure improvement in mood and ability to live a normal life.

5. QALYs QALY stands for the Quality Adjusted Life Year QALY = 1 means a person has 1 year of life in perfect health.

6. Measuring QALY Five criteria are used: Mobility Self-care Usual activities Pain/discomfort Anxiety/depression Score 1.I have no problems walking about. 2.I have some problems walking about. 3.I am confined to bed.

7. Measuring QALY Five criteria are used: Mobility Self-care Usual activities Pain/discomfort Anxiety/depression Score 1.I have no problems with self-care. 2.I have some problems washing or dressing myself. 3.I am unable to wash or dress myself.

8. Measuring QALY Five criteria are used: Mobility Self-care Usual activities Pain/discomfort Anxiety/depression Score 1.I have no problems with performing my usual activities. 2.I have some problems with performing my usual activities. 3.I am unable to perform my usual activities.

9. Measuring QALY Five criteria are used: Mobility Self-care Usual activities Pain/discomfort Anxiety/depression Score 1.I have no pain or discomfort. 2.I have moderate pain or discomfort. 3.I have extreme pain or discomfort.

10. Measuring QALY Five criteria are used: Mobility Self-care Usual activities Pain/discomfort Anxiety/depression Score 1.I am not anxious or depressed. 2.I am moderately anxious or depressed. 3.I am extremely anxious or depressed.

11. Assessing a new treatment NICE (National Centre for Clinical Excellence) assesses new treatments on the basis of: What improvement in QALY do they offer? How does the cost of a new treatment compare with the cost of existing treatment? Is the gain in QALY sufficient to justify any additional cost? So is the new treatment cost effective?