ABSTRACT
In the previous chapter we looked at cases where different individuals have different prospects for improvement in their quality of life as a result of treatment, and we asked what implications these differences have for the QALY approach. The situation is rather different when some people will experience a poorer quality of life after treatment no matter how successful the treatment is, for reasons which are unre lated to their current health problems. Imagine that Arne and Zach have been involved in car accidents and suffered injuries identical to those suffered by Nora and Agnes, respectively, with one important difference: there is no treatment that can help either Arne or Zach. For the rest of his life, Arne must expect to be confined to a wheelchair with persistent and often severe back pain; and Zach will walk with a limp for as long as he lives. If these were the only medical problems afflicting Arne and Zach, they would both have a life expectancy of 40 years. Unfortunately, however, both suffer serious heart conditions which, without treatment, will rapidly prove fatal. A heart transplant offers the only hope, at a cost of $100 000. What are the QALY implica tions of providing heart transplants for Arne and Zach?
