We welcome the letter from Dr Basu,1 lead author of the Health Years in Total (HYT) approach.2
Dr Basu acknowledges our finding that the HYT approach may violate “independence of irrelevant alternatives” (IIA), a fundamental axiom of rational choice theory. As noted in our article, social decision makers should respect IIA because violations would be difficult to defend if subjected to legal challenge.3 In response to Dr Basu’s acknowledgment, we reaffirm our recommendation that decision makers should avoid the HYT approach.
We would also like to address several other matters raised in Dr Basu’s letter.