Alternatives to the QALY measure for economic evaluations

Abstract

Economic analyses (i.e., analyses that are concerned primarily with questions of resource allocation) are becoming more common in health care in general and care of cancer patients in particular. The most commonly used measure for the valuation of outcome in such analyses is the QALY (quality-adjusted life-years), which combines qualitative (i.e., quality of life) and quantitative (i.e., survival) aspects of the outcome into one dimension. Using economics (i.e., the discipline) as the mode of thinking to help solve problems of resource allocation in health, this paper describes a framework to evaluate the appropriateness of use of a measure of outcome in the context of an economic evaluation. This framework will be used to critically appraise the use of the QALY measure and of two alternative measures, HYE (healthy years equivalent) and WTP (willingness to pay), in economic evaluations of health care interventions. The paper also describes a practical tool that can be used to measure individuals' WTP in the context of public decision making. This tool involves modifying the decision board, a tool develop (originally in the cancer area) to help clinicians present information to patients. The intent is to show that the use of a theoretically superior measure of outcome need not always be empirically restrictive.

The application of pharmacoeconomic modelling to estimate a value‐based price for new cancer drugs

“…1). In the current study, quality‐adjusted life periods were measured as ‘healthy months equivalent’ for the time spent in each outcome of the decision model using the Time Trade‐off technique [24,25]. Healthy month equivalence scores measure patient utilities for a given health state.…”

Cost-Effectiveness of Aprepitant for the Prevention of Chemotherapy-Induced Nausea and Vomiting Associated with Highly Emetogenic Chemotherapy

“…Mean HDEs were used in the base‐case analysis. Incremental benefit was converted to quality‐adjusted life‐years (QALYs), by dividing the difference in the mean HDEs for each treatment by 365 to estimate the number of healthy year equivalents (HYEs) gained [41]. When the TTO method is used to elicit utilities, estimation of HYEs and QALYs utilize the same assumptions and yield theoretically identical results [42,43].…”

Economic analysis of albumin-bound paclitaxel for the treatment of metastatic breast cancer

“…In the current study, quality adjusted life years (QALYs) were measured as 'healthy months equivalence' for the time spent in each health state using the time trade-off technique. 12,13 The scores in months were then converted to utility measures between 0 and 1, where 0 represented death and 1 was a state of perfect health or optimal quality of life. Scores in healthy month equivalence were also converted into QALYs by dividing by 12 months.…”