Skip navigation
Link to Back issues listing | Back Issue Listing with content Index | Subject Index

On value (Editorial)

People and pounds

On value

Value is a really difficult thing to define. There are some great quotes about value, like the famous Oscar Wilde definition of a cynic as a man who knows the price of everything and the value of nothing. Across the water in the USA, HL Mencken quipped that the chief value of money lies in the fact that one lives in a world in which it is overestimated.

Neither of which is particularly useful in exploring what value means in healthcare. There is a narrow definition, that of a cost per quality adjusted life year (QALY). Informally we tend to accept in the UK that anything with a cost per QALY of £30,000 or less is good value, and if it is more than that it is poor value.

That's fine as far as it goes. The trouble is that calculating a cost per QALY is not always the easiest thing in the world. First you need a cost, and then you need a QALY. Given that in some circumstances there can be considerable uncertainty, then opportunities for disagreement are probable - they occur when cost is high and quality of life low, with uncertainty in both.

People and pounds

What affects people most, and what costs most, do not always coincide. Chronic conditions in older people are an example of this, and there is some smashing data to demonstrate the dichotomy in older people. Conditions that negatively affect health status are not always the most expensive to treat, making one think about relative values.

The value of glucose monitoring for people with type 2 diabetes is a topic well worth revisiting, since new RCTs have delivered four times more information about the benefits of monitoring than a previous meta-analysis of small trials.

The message is that blood, but not urine, monitoring reduces glycated haemoglobin, and reduces later complications. Another message is that while some people do particularly well, others do not, so average results are of limited value.

next story