“The trouble with QALYs…”

Abstract

Abstract. This paper summarises the use of QALYs in evaluating changes in mental health states, highlighting the benefits and challenges of their use in this field. The general principles underlying the QALY measure and the most common methods of measuring QALYs are discussed briefly. Evidence of the usefulness and problems of using this generic measure of health-related quality of life are provided from a sample of recent studies relating to depression, schizophrenia, attention deficit hyperactivity disorder and dementia. In each case, attempts were made to use QALYs to measure changes in health states. While in principle, the QALY is enormously attractive, its suitability for measuring changes in many mental health conditions remains open to doubt as existing tools for generating QALY scores such as the EQ-5D have tended not to perform sufficiently well in reflecting changes in many mental health states. New developmental work is needed to construct better QALY-measuring tools for use in the mental health field. Both the conceptualisation and measurement of QALYs need to be built on a valid, comprehensive model of quality of life specific to a mental health disorder, to ensure that the resultant tool is sensitive enough to pick up changes that would be expected and seen as relevant in the course of the illness. CHOOSING BETWEEN ALTERNATIVESObviously, the main aims of a mental health system are to alleviate symptoms and improve quality of life, but it is widely appreciated that regard must also be paid to the economic consequences of the treatments and support arrangements that are offered. One consequence has been the growing attention paid to the cost-effectiveness as well as the effectiveness of health care interventions. The underlying reason is scarcity: there are insufficient resources to meet all of a society's needs or demands, and so difficult choices have to be made between competing uses of those resources. In particular, decision makers with responsibility for allocating resources must weigh up the outcomes achieved in those various different uses of resources and the costs of achieving them. This is quite a challenge when the outcomes are measured in different ways. How, for example, is a decision maker to compare cancer treatment with a psychological intervention for depression or a health promotion campaign to reduce coronary heart disease? HEALTH ECONOMIC EVALUATIONS -BROADENING OUTWhen a new treatment is developed or introduced decision makers face two central questions. The clinical question is whether the intervention (say a new antidepressant) is more effective than existing interventions in alleviating depressive symptoms and generally improving health and quality of life. If the answer to the clinical question is that the new medication is no better than existing options, then there is usually no need to consider its use any further. But if it looks clinically effective, the decision maker will then want an answer to a second question: is it cost-effective? That is, does the treatment ach...

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