#qaly

[inside-to-outside-thoughts]

Im constantly grieving versions of myself that could have been

[autisticadvocacy]

One voice that has been glaringly absent from this debate is the most important voice: patients.

“Only about one-quarter of participants believed [the Quality-Adjusted Life Year]  was a good way to measure value in health care… Participants were highly reticent of the use of the QALY by external decision makers, who would have the ability to impact their access to care.”

[autisticadvocacy]

Chairman's Corner: ICER Should Join Others in Moving Beyond QALYs

The Partnership to Improve Patient Care (PIPC) has a long history advocating for the perspectives of patients and people with disabilities t

“As part of this work, we encourage ICER to consider innovative methodologies beyond flawed cost effectiveness methodologies that use a quality-adjusted-life-year (QALY) or similar metric.”

[sanidato]

Resource Allocation Metrics: Analyzing Global Preferences for Saving Lives versus Life-Years

A 2026 global analysis evaluates the fundamental tension in healthcare planning between prioritizing the total number of individuals saved versus the total volume of healthy life-years gained, highlighting how health system design influences public preference.

Read the full article

[principleofplenitude]

QALYs ignore or assume away some issues, like fairness and distributional concerns. If a QALY-based approach suggested that health interventions for men yield higher QALYs than for women, should we fund health care accordingly? Few would find that fair. A related area of concern is motivated by the question: Whose preferences are embodied in QALYs and whose should be? Should QALYs reflect the preferences of individuals experiencing various health states or the preferences of individuals imagining different health states? Or, should QALYs reflect societal value of health?

“What’s wrong with QALYs?” from Incident Economist

[ogilvyhealthworldmarketaccess]

Is NICE doing more harm than good?

Last year, the National Institute for Health and Care Excellence (NICE) proposed increasing the upper bound of the cost-effective threshold to £50, 000 per quality-adjusted life year (QALY) for drugs which offer health benefits for diseases with high burden of disease. However, a recent paper has argued that increasing the price paid for treatment of these diseases may result in displacement of health in other disease areas.

The paper, by Professor Karl Claxton, suggests that the current upper limit of £30,000 is too high and that a threshold of £20,000 per QALY may be a more appropriate ‘basic threshold’. It is claimed that NICE’s £30,000 threshold may be diverting funding away from other areas of care where it could be better spent.

The paper’s findings have been queried by the Office of Health Economics which argues that the assumptions that Claxton has made have led to high uncertainty and a lack of sensitivity in their findings.

What is clear however, is that there is considerable political and public pressure on NICE’s decision-making process, not least with the recent news that most MPs are seeking for NICE’s process to be reviewed. Somehow the institute must stay impartial in its judgements and balance the diversity of stakeholder demands, ensuring that the maximum benefit for society is achieved through healthcare spending.

[theswitchproject]

OHE has published an Occasional Paper by Barnsley et al. highlighting the significant shortage of data that forced the Claxton et al. study to rely on a large number of strong assumptions to produce their results (Barnsley et al., 2013). In this critique, Barnsley et al. argue that the estimate of £13,000 per QALY is highly uncertain and sensitive to the adoption of plausible alternative assumptions. This was echoed in a journal article by Professor Raftery which compared the Barnsley et al. critique with the Claxton et al. assumptions – NICE’s Cost-Effectiveness Range: Should it be Lowered? His answer was “No” as “the assumptions required are too many and sweeping to be the basis of a major policy change”.

[theswitchproject]

Cost-effectiveness analysis involves the comparison of the incremental cost-effectiveness ratio of a new technology, which is more costly than existing alternatives, with the cost-effectiveness threshold. This indicates whether or not the health expected to be gained from its use exceeds the health expected to be lost elsewhere as other health-care activities are displaced. The threshold therefore represents the additional cost that has to be imposed on the system to forgo 1 quality-adjusted life-year (QALY) of health through displacement. There are no empirical estimates of the cost-effectiveness threshold used by the National Institute for Health and Care Excellence.