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Health outcome models for policy analysis.

The increasing therapeutic options in health care have created new dilemmas because resources to pay for the new technologies are limited. Cost/effectiveness and cost/utility models are required in order to evaluate the return on the invested dollar for various health care technologies. The problem is that different technologies are often evaluated using very different outcome units. The alternatives may range from liver transplantation to rehabilitation to preventive care. This article presents an overview of a general health policy model that expresses the benefits of all programs in a common unit known as the well-year--defined as the equivalent of 1 completely well year of life. The model uses two data sources: life expectancy and health-related quality of life during years prior to death. The quality-of-life component considers behavioral scales for mobility, physical activity, social activity, and symptoms. These dimensions are weighted by utility or preference to create a single scale that ranges from 0 (for death) for 1.0 (for optimum health). The model also considers duration of stay in each health state. Because all providers in health care attempt to extend life expectancy and improve quality of life, very different approaches in health care can be evaluated against one another. Preliminary analyses suggest that some behavioral interventions compete favorably with traditional medical and surgical treatments in terms of cost/well-year of life production. Various applications of the model are discussed.