ARE QALYs INHERENTLY BIASED IN FAVOR OF PREVENTION OVER CURE?

YES, WHEN YOU ARE TALKING ABOUT ZAMBIA AND BURKINA FASO*

An article in Slate Magazine, “Wrong Number: Is it Cost Effective to Treat the World’s Poor”, written by pediatric cardiologist Darshak Sanghavi, triggered the Author’s interest in revisiting QALYs. Sanghavi begins the Slate article with the story of one of his former students working in a remote Zambian clinic. A three-year old boy, weighing only 15 pounds, was admitted to the malnutrition clinic. When the student listened to the boy’s heart, the student determined that the boy had a serious heart malformation.

The student then emailed her former professor Sanghavi and asked it there were any inexpensive drugs that she could give the child. Sanghavi replied to the email stating that unfortunately, there were no drugs that could help the child. And without surgery, the child would almost certainly die.

THE ZAMBIAN MEDICAL SYSTEM DOES NOT HAVE THE RESOURCES TO HELP THE BOY

Sanghavi notes the seemingly obvious:

Pediatric heart surgery is fabulously expensive, often costing hundreds of thousands of dollars per case in the United States. Thus it would be foolhardy, goes the thinking, to offer surgery to poor African children who live on less than a few dollars per week. Isn't it better to invest in more cost-effective public-health measures, like mosquito netting to prevent malaria and vaccines against diarrhea? For decades, this kind of reasoning has been used to deny expensive but lifesaving treatments to the world's poor, most notably for HIV infection, in favor of more cost-effective measures focused on prevention. Dollar-for-dollar prevention is supposed to yield greater aggregate quality-of-life benefits than actual treatment.

Sanghavi then states that this argument, prevention buying lots cheap QALYs over expensive intervention, rigs the game so that the world’s poor will rarely receive expensive but effective medical care.

Know what? He is right. QALYs are economic calculations, not moral pronouncements. But unfortunately, money is a devilish limit upon otherwise salutary aims. And even the angels cannot manufacture more of it.

SO WHAT THEN IS TO BE DONE?

Most of the readers know that the author is an economic conservative and a social liberal. Nay, social radical. He believes that everyone on earth deserves a minimum level of support, food and health care. (Even uninsured Americans.)

To that end, he further believes that developed countries, and emerging developed nations such as China and India, should be required to pay some percentage of their GNP, perhaps around 5%, to developing nations to eliminate hunger, provide medical care, alleviate poverty, and stimulate economic development. Of course the Author recognizes that the governments of some developing nations (and at least one large developed nation) are riddled with corruption. In all cases the funds drawn from developed nations should be provided to the government and NGOs. In cases where the governments are so corrupt that they cannot be trusted with the resources, the proceeds should go to NGOs.

If there are better solutions, the Author would like to hear them.

ESCHEWING THE CULT OF NATIONALISM SINCE 2001 IN THE DESERT OF THE REAL!


*Zambia and Burkina Faso are relatively poor, developing countries in Africa. The Author is confident that his loyal readers already know this, but offers this explanation for newcomers.