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Quality Adjusted Life Years
Quality Adjusted Life Years
Mark Reid
Class of 2007/2008
24/03/08
Quality Adjusted Life Years (QALYs) are one method used by health
economists to measure the quantity and quality of life gained from various
gained from each different intervention. For example; cancer drug A may
provide a patient suffering from liver cancer with 0.25 QALYs per treatment
whereas surgery could provide the same patient with 0.5 QALYs. If the cost
of the drug was £200 per treatment and the cost of surgery was £600 per
operation then the more cost effective option would be the drug (0.25 X £200
Weightings
There are a variety of ways weighting different QALY assessments, each with
are Time Trade Off (TTO), Standard Gamble (SG), Person Trade Off (PTO)
The TTO method of weighting suggests that there are negative or positive
effects on the length of time that a patient can live in perfect health based on
the options available to them. For example; a patient with an illness or
disability could choose to live five years in their current condition of less than
perfect health or could trade off some length of their life to live at a higher
quality of life, for instance by choosing an operation that may improve their
current condition but shorten their life expectancy. This method is particularly
effective when looking at cancer drugs that often can cause remission for a
period of time but may cause the cancer to return and progress at a greater
rate than if they had not had the drug. This method is a good system in terms
of patients, but has some drawbacks which are covered in greater detail later
in this paper.
The second methodology is the SG method. This system asks the patient
whether or not the options of intervention is weighed more valuably than the
continue life in their existing condition or whether they should take the chance
on the intervention, almost all of which carry some degree of risk of making
risky operation that could allow them to walk again but carries with it a thirty
percent chance that they could die on the operating table. If the patient
weighs the possibility of being able to walk greater than the risk that the
operation could result in their death then they may choose to have the
possibility of death then they may choose not to “gamble” their utility on the
procedure.
The third methodology is the PTO. This in essence says that it is up to the
important than providing two or more people with a different disease the
treatment for their malady with a cumulative value equivalent to the cost of the
patients versus hip replacements. If you are able to carry out five cataract
operations for the cost of two hip replacements, then where would it be most
opinion this is the most politically driven and least clinically driven of all of the
methodologies.
Lastly is the VAS methodology. With this style of assessing need patients are
asked to value their health on a scale of zero to one hundred, with zero being
dead (admittedly, few patients often value themselves at this level) and one
hundred being perfect health. This methodology has the flaw that it is
probably the most subjective of all of the methods. What one person may
another patient would say. Additionally, patients are rarely in the position
intellectually to make this call. A person with high blood pressure or other
actually are. This is however the simplest of methods for frontline clinicians to
other tests unless there was some reason behind their thinking.
EUROQOL EQ-5D
and subsequent quality of life, is the EUROQOL EQ-5D index. This simple
health status and then scores them out of three. The various metrics on this
determine the final quality of life score. The perfect score for a person in
perfect health is 11111 and a score of 33333 would indicate that the patient
This system has been developed and tested using a very large control group
however there are several drawbacks to this method that would make it
conjunction with another methodology in order to ensure that the results are
accurately reflecting the patient’s quality of life rather than using it on its own.
The biggest drawback to the EUROQOL EQ-5D index is the simplicity of it.
With scores of only one to three there is a considerable amount of space for
interpretation and many of the questions and weightings reflect that. When
assessing a patient’s condition against this index at the macro level it could be
person with one form of cancer may have a lower tolerance to pain than
another patient and yet this is not accurately reflected in the scores. The
weighting scores reflect what the sample group that was involved in the
development of the index may have thought however they may not reflect
would consider it to be severe yet there was a disparity in what the GPs
thought was sufficient pain relief. The EQ-5D would have ranked my pain as
a two out of a possible three yet I would have ranked it somewhere around a
three or four out of a possible ten. The EQ-5D therefore cannot accurately
broken bone, etc.), and severe pain (migraine, cancer, post-operative pain,
The Drawbacks
biggest complaints that exists with QALY assessment at the macro economic
level is that it doesn’t take externalities into account. When health planners
it is difficult, or impossible, to assess the full effect that the various treatments
will have on the families and friends of the patients or on society as a whole.
and having a respite care bed available in a community can make a huge
difference to the lives of families and carers that have to take care of elderly,
measure in terms of value however they can make a large difference to the