The use of Quality-Adjusted Life Years in cost-effectiveness analyses in palliative care: Mapping the debate through an integrative review

Wichmann, Anne; Adang, Eddy; Stalmeier, Peep F. M.; Kristanti, Martina Sinta; Block, Lieve Van den; Vernooij-Dassen, M.J.F.J.; Engels, Yvonne

doi:10.1177/0269216316689652

Cited by 49 publications

(59 citation statements)

References 77 publications

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“…Proposition regarding the main issues of the QALY discussion originating from the earlier mentioned review, (12) formed the rounds of the NGT. They were: I.…”

Section: Procedures Of the Nominal Groupsmentioning

confidence: 99%

“…By means of systematic international expert discussions, a conceptual discussion regarding the use of the QALY in palliative care was held in this study. Earlier identi ed issues (12) were re ected upon and discussed with international experts in order to reach consensus on these issues, and to advise on the QALY's future use in policy and practice. These issues among others concerned the QALY possibly being more valuable for palliative care when QoL questionnaires used take into account issues important to palliative patients (such as patient dignity, spiritual and psychosocial wellbeing and closure), and the possibility of integrating valuation of time in a non-linear way in the QALY.…”

Section: Main Ndingsmentioning

confidence: 99%

“…(11) The QALY debate in palliative care was recently mapped in an integrative review. (12) In three themes, this review described which problems are encountered when using the QALY in the palliative care context: restrictions in life years gained; conceptualization of QoL and its measurement including suggestions to adapt this, and; issues around valuation and additivity of time, referring to changing valuation of time. In this review, it among others was concluded that the QALY might be more valuable for palliative care when QoL questionnaires taking into account issues important to palliative patients (such as patient dignity, spiritual and psychosocial wellbeing and closure) are used, and that the possibility of integrating valuation of time in a non-linear way in the QALY should be explored.…”

Section: Introductionmentioning

confidence: 99%

“…Since the eld is moving forward, and in order to take the next step in this debate, in this study we brought together diverse stakeholders in order to have a conceptual discussion -overarching economic arguments -regarding the use of the QALY in palliative care; where are we going? The aim of this article was to report on, and draw conclusions from these international meetings in which experts re ected upon the abovementioned issues in order to reach consensus on the identi ed QALY issues, (12) and to advise on the QALY's future use in practice and policy.…”

Section: Introductionmentioning

confidence: 99%

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QALY-Time: Experts’ View On The Use Of The Quality-Adjusted Life Year In Cost-Effectiveness Analysis In Palliative Care

Wichmann¹,

Goltstein²,

Obihara³

et al. 2020

Preprint

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Abstract Background. The Quality-Adjusted Life Year (QALY) is internationally recognized as standard metric of health outcomes in cost-effectiveness analyses (CEAs) in healthcare. The ongoing debate concerning the appropriateness of its use for decision-making in palliative care has been recently mapped in a review. The aim was to report on and draw conclusions from two expert meetings that reflected on earlier mapped issues in order to reach consensus, and to advise on the QALY’s future use in palliative care. Methods. A nominal group approach was used. In order to facilitate group decision making, three statements regarding the use of the QALY in palliative care were discussed in a structured way. Two groups of international policymakers, healthcare professionals and researchers participated. Data were analysed qualitatively using inductive coding. Results. 1) Most experts agreed that the recommended measurement tool for the QALYs ‘Q’ component, the EuroQol-5D (EQ-5D), is inappropriate for palliative care. A more sensitive tool, which might be based on the capabilities approach, could be used or developed. 2) Valuation of time should be incorporated in the ‘Q’ part, leaving the linear clock time in the ‘LY’ component. 3) Most experts agreed that the QALY, in its current shape, is not suitable for palliative care. Conclusions. 1) Although the EQ-5D does not suffice, a generic tool is needed for the QALY. As long as no suitable alternative is available, other tools can be used besides or serve as basis for the EQ-5D because of issues in conceptual overlap. 2) Future research should further investigate the valuation of time issue, and how best to integrate it in the ‘Q’ component. 3) A generic outcome measure of effectiveness is essential to justly allocate healthcare resources. However, experts emphasized, the QALY is and should be one of multiple criteria for choices in the healthcare insurance package.

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“…Proposition regarding the main issues of the QALY discussion originating from the earlier mentioned review, (12) formed the rounds of the NGT. They were: I.…”

Section: Procedures Of the Nominal Groupsmentioning

confidence: 99%

Section: Main Ndingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

QALY-Time: Experts’ View On The Use Of The Quality-Adjusted Life Year In Cost-Effectiveness Analysis In Palliative Care

Wichmann¹,

Goltstein²,

Obihara³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

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“…However, as the MORECare statement (3) -which promotes consensus on methods for end of life care research-indicated, there are 'strongly opposing' views about the use of quality adjusted life years (QALYs) in the end of life care context. This lack of consensus is apparent from the relatively small literature in this area (4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Appropriate frameworks for economic evaluation of end of life care: A qualitative investigation with stakeholders

Kinghorn

Coast

2019

Palliat Med

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Background: The use of quality-adjusted life years rests on the assertion that the objective of the health care system is to improve health. Aim: To elicit the views of expert stakeholders on the purpose and evaluation of supportive end of life care, and explore how different purposes of end of life care imply the need for different evaluative frameworks. Design: Semi-structured qualitative interviews, analysed through an economic lens using a constant comparative approach. Participants: Twenty professionals working in or visiting the United Kingdom or Republic of Ireland, with clinical experience and/or working as academics in health-related disciplines. Results: Four purposes of end of life care were identified from and are critiqued with the aid of the qualitative data: to improve health, to enable patients to die in their preferred place, to enable the patient to experience a good death, and to enable the patient to experience a good death, and those who are close to the patient to have an experience which is as free as possible from fear, stress and distress. Conclusion: Managing symptoms and reducing anxiety were considered to be core objectives of end of life care and fit with the wider health service objective of improving/maximising health. A single objective across the entire health system ensures consistency in the way that resource allocation is informed across that entire system. However, the purpose of care at the end of life is more complex, encompassing diverse and patient-centred objectives which we have interpreted as enabling the patient to experience a good death.

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Healthcare Interventions for Improving Access

2019

Healthcare System Access

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The use of Quality-Adjusted Life Years in cost-effectiveness analyses in palliative care: Mapping the debate through an integrative review

Cited by 49 publications

References 77 publications

QALY-Time: Experts’ View On The Use Of The Quality-Adjusted Life Year In Cost-Effectiveness Analysis In Palliative Care

QALY-Time: Experts’ View On The Use Of The Quality-Adjusted Life Year In Cost-Effectiveness Analysis In Palliative Care

Appropriate frameworks for economic evaluation of end of life care: A qualitative investigation with stakeholders

Healthcare Interventions for Improving Access

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