ABSTRACT
Cost-utility analysis currently constitutes the gold standard of health economic evaluation (see Sculpher et al. 2005: 14). In contrast to CBA, it couches medical benefits in terms of health-related quality of life (HrQOL), usually measured by the quality-adjusted life year (QALY).1 The first attempt to actually allocate resources on the basis of CUA in Oregon famously failed, though. This event and the debate it provoked made it abundantly clear that the application of CUA faces serious fairness issues as well. The first part of this chapter scrutinizes the QALY concept and illustrates the happenings in Oregon. Thereby, the reaction to CUA’s empirical failure on part of the health economists is of particular interest: they generally argued that the fairness problems could be accounted for within the framework of economic evaluation by means of a further modification of the outcome measure, i.e., by equity weighting of QALYs (see Lübbe 2015: 35). The second part of the chapter connects the discussion on health economic evaluation with a fundamental issue of moral philosophy by characterizing economic evaluation as applied consequentialism. It points out that the path from CBA to the weighting approaches resembles the development from hedonic utilitarianism to different types of consequentialism, applying ever more sophisticated theories of value. Both consequentialist moral theories and the equity approaches thus present attempts to surmount counterintuitive distributional implications of utilitarianism and CUA respectively by means of modifying the axiology while leaving the value maximizing framework intact (see Lübbe 2015: 33, 35).2 These considerations provide the conceptual background for the critique of the weighting approaches and social value maximization in Chapters 5 and 6.
