Prostate Cancer.

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   I'm sure Abbey knows - though others may not - that cost-benefit calculations are considered by the NHS and other bodies... sometimes, using QALYs. This considers quality of life and life duration - is it better (say, from the patient's POV) to live with better quality for a shorter time (say, without using an aggressive treatment), or to live longer with treatment, but with lower quality? Those are individual decisions. 
AFAIK, the body which advises the NHS on the allocation of limited resources - NICE (the National Institute for health and Care Excellence) uses QALYs to decide which medicines and (I think) which treatments to approve. I assume this also goes for screening programmes. 

Naturally, this leads to tensions. I get a bit annoyed by stories in the tabloid press that patient X or Y needs some drug costing (say) £2 million, which will enable them to live for an extra 6 months or whatever. These sob stories don't help anyone. There has to be a degree of fairness in the allocation of the money available, and here you'd think that the greater good of the many should outweigh the benefits to a very few. Of course we'd all like to live forever in perfect health - but it ain't gonna happen. So special pleading can be a bit annoying.

Having said that, there are definitely debates to be had. An excerpt from Wikipedia:

The method of ranking interventions on grounds of their cost per QALY gained ratio (or ICER) is controversial because it implies a quasi-utilitarian calculus to determine who will or will not receive treatment.^[23] However, its supporters argue that since health care resources are inevitably limited, this method enables them to be allocated in the way that is approximately optimal for society, including most patients. Another concern is that it does not take into account equity issues such as the overall distribution of health states—particularly since younger, healthier cohorts have many times more QALYs than older or sicker individuals. As a result, QALY analysis may undervalue treatments which benefit the elderly or others with a lower life expectancy. Also, many would argue that all else being equal, patients with more severe illness should be prioritized over patients with less severe illness if both would get the same absolute increase in utility.

https://en.wikipedia.org/wiki/Quality-adjusted_life_year

Edited by aber-fan - 02 December 2025 at 2:57pm