scholarly journals Measurement, modeling and QALYs

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1048
Author(s):  
Paul C. Langley ◽  
Stephen P. McKenna
Keyword(s):  
Quality Adjusted Life Year ◽  
Response To Therapy ◽  
Value Assessment ◽  
Scaling Properties ◽  
Ratio Scales ◽  
Utility Scale ◽  
Allocation Decisions ◽  
Inform Resource Allocation ◽  
Quality Adjusted Life ◽  
Utility Measures

Over the past 30 years, a mainstay of health technology assessment has been the creation of modeled incremental cost-per-quality adjusted life year (QALY) claims. These are intended to inform resource allocation decisions. Unfortunately, the reliance on the construction of QALYs from generic utility scales is misplaced. Those advocating QALY-based lifetime modeled claims fail to appreciate the limitations placed on these constructs by the axioms of fundamental measurement. Utility scales, such as those created by the EQ-5D-3L instrument, are nothing more than multidimensional, ordinal scales. Such scales cannot support basic arithmetic operations. Interval scales can support addition and subtraction; ratio scales the further operations of multiplication and division. Those who advocate the construction of QALYs fail to appreciate that such an operation is only possible if the utility scale is unidimensional and has ratio properties with a true zero. The utility measures available do not meet these requirements. As we cannot produce meaningful utility values, the QALY is an invalid construct. Consequently, cost-per-incremental QALY claims are impossible to sustain and the application of cost-per QALY thresholds meaningless. As utility is a latent, unidimensional variable, the best a measure of utility could achieve would be unidimensionality and interval scaling properties. Where such measures are available, they could support claims for response to therapy. Consequently, there would be no need to continue constructing imaginary lifetime value assessment frameworks. Admitting that the QALY is a fatally flawed construct means rejecting 30 years of cost-per-QALY models.

The Path Forward

2021 ◽  
pp. 240-246
Author(s):  
Neumann Peter J. ◽  
Cohen Joshua T. ◽  
Ollendorf Daniel A
Keyword(s):  
Societal Perspective ◽  
Late Stage ◽  
Drug Price ◽  
Quality Adjusted Life Year ◽  
Value Assessment ◽  
Drug Prices ◽  
Leading Role ◽  
Starting Point ◽  
Length Of Life ◽  
Quality Adjusted Life

Factors interfering with market-based alignment of drug prices and value make explicit value assessment necessary. The widely used quality-adjusted life year serves as a starting point because it accounts for both quality and length of life. Cost estimates could improve by accounting for drug price changes accompanying the loss of market exclusivity. Consistent use of a societal perspective when relevant would also improve value assessments. Prices should sometimes reflect government contributions to development, although such adjustments make the most sense when government facilitates late-stage research. The Institute for Clinical and Economic Review, a private group with a leading role in US value assessment, should make its analyses transparent and defer to payers regarding judgements about value. Finally, payers should embrace value-based pricing. They may not always get the lowest prices, but aligning price and value will mean society expends its resources efficiently and improves the population’s overall health.

scholarly journals Valuing Health for Clinical and Economic Decisions: Directions Relevant for Rheumatologists

2011 ◽  
Vol 38 (8) ◽  
pp. 1770-1775 ◽  
Author(s):  
MARK J. HARRISON ◽  
NICK J. BANSBACK ◽  
CARLO A. MARRA ◽  
MICHAEL DRUMMOND ◽  
PETER S. TUGWELL ◽  
...  
Keyword(s):  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Point Of View ◽  
Health State ◽  
Utility Analysis ◽  
Economic Decisions ◽  
Pros And Cons ◽  
Allocation Decisions ◽  
Qaly Approach ◽  
Quality Adjusted Life

The quality-adjusted life-year (QALY) is a construct that integrates the value or preference for a health state over the period of time in that health state. The main use of QALY is in cost-utility analysis, to help make resource allocation decisions when faced with choices. Although the concept of the QALY is appealing, there is ongoing debate regarding their usefulness and approaches to deriving QALY. In 2008, OMERACT engaged in an effort to agree on QALY approaches that can be used in rheumatology. Based on a Web questionnaire and a subsequent meeting, rheumatologists questioned whether it was relevant for OMERACT (1) to investigate use of a QALY that represents the patients’ perspective, (2) to explore the validity of the visual analog scale (VAS) to value health, and (3) to understand the validity of mapping health-specific instruments on existing preference instruments. This article discusses the pros and cons of these points in light of current insight from the point of view of health economics and decision-making theory. It also considers the further research agenda toward a QALY approach in rheumatology.

Institute for Clinical and Economic Review

2021 ◽  
pp. 112-141
Author(s):  
Neumann Peter J. ◽  
Cohen Joshua T. ◽  
Ollendorf Daniel A
Keyword(s):  
Impact Analysis ◽  
The United States ◽  
Quality Adjusted Life Year ◽  
Value Assessment ◽  
Private Organization ◽  
Wide Range ◽  
Powerful Approach ◽  
Assessment Approach ◽  
Contextual Elements ◽  
Quality Adjusted Life

Although its origins date to 2006, the Institute for Clinical and Economic Review (ICER) gained prominence around 2015 when it focused its health technology assessment (HTA) efforts on a new highly effective, though expensive, treatment for hepatitis C. ICER, a small, private organization, seemed to fill a void in the United States because it offered a systematic value assessment approach and made its analyses publicly accessible. Drawing inspiration from England and Wales’ HTA body, ICER has used the quality-adjusted life year (QALY) and cost-effectiveness analysis. That decision gives ICER a powerful approach applicable to a wide range of technologies, but it has also spurred controversy. The organization has responded to criticisms by revising its “value framework.” Changes include separation of budget impact analysis from value determinations, introduction of other value measures beyond the QALY, increasing consideration of contextual elements, and adoption of a “societal perspective” where data support it.

scholarly journals Measuring the cost-effectiveness of treatments for people with multiple sclerosis: Beyond quality-adjusted life-years

2020 ◽  
pp. 135245852095417
Author(s):  
Annie Hawton ◽  
Elizabeth Goodwin ◽  
Kate Boddy ◽  
Jennifer Freeman ◽  
Sarah Thomas ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cost Effectiveness ◽  
Quality Adjusted Life Year ◽  
Usual Practice ◽  
The United Kingdom ◽  
Treatment Benefits ◽  
Life Years ◽  
The Cost ◽  
Allocation Decisions ◽  
Quality Adjusted Life

Background: It is a familiar story. A promising multiple sclerosis (MS) treatment clears the three regulatory hurdles of safety, quality and efficacy, only to fall at the fourth: cost-effectiveness. This has led to concerns about the validity of the measures typically used to quantify treatment effects in cost-effectiveness analyses and in 2012, in the United Kingdom, the National Institute for Health and Care Excellence called for an improvement in the cost-effectiveness framework for assessing MS treatments. Objective and Methods: This review describes what is meant by cost-effectiveness in health/social care funding decision-making, and usual practice for assessing treatment benefits. Results: We detail the use of the quality-adjusted life-year (QALY) in resource allocation decisions, and set out limitations of this approach in the context of MS. Conclusion: We conclude by highlighting methodological and policy developments which should aid addressing these limitations.

scholarly journals The National Pharmaceutical Council: Endorsing the Construction of Imaginary Worlds in Health Technology Assessment

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 119
Author(s):  
Paul C Langley
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Quality Adjusted Life Year ◽  
Normal Science ◽  
Value Assessment ◽  
Assessment Framework ◽  
Professional Groups ◽  
A Value ◽  
Quality Adjusted Life

All too often, organizations embrace standards for health technology assessment that fail to meet those of normal science. A value assessment framework has been endorsed that is patently in the realm of pseudoscience. If a value assessment framework is to be accepted, then claims for the value of competing products must be credible, evaluable and replicable. If not, for example, when the assessment relies on the construction of an imaginary lifetime incremental cost-per-quality-adjusted-life-year (QALY) world, then that assessment should be rejected. Such an assessment would fail one of the central roles of normal science: the discovery of new facts through an ongoing process of conjecture and refutation where provisional claims can be continually challenged. It is no good defending an endorsement of a value framework that fails expected standards on the grounds that it has been endorsed by professional groups and reflects decades of development. This is intellectually lazy. If this is the case, then the scientific revolution of the 17th century need not have happened. The purpose of this commentary is to consider the recommended standards for health technology assessment of the National Pharmaceutical Council (NPC), with particular reference to proposed methodological standards in value assessment and the commitment to mathematically impossible QALYs.

Costs and the cost-effectiveness threshold

2017 ◽  
Author(s):  
Jan Abel Olsen
Keyword(s):  
Societal Perspective ◽  
Threshold Value ◽  
Quality Adjusted Life Year ◽  
Healthcare Sector ◽  
The Difference ◽  
The Cost ◽  
Qaly Threshold ◽  
Cost Effectiveness Threshold ◽  
Effectiveness Threshold ◽  
Quality Adjusted Life

Chapter 19 starts by distinguishing between the two contrasting perspectives that an economic evaluation would take: the healthcare sector perspective versus the societal perspective. The former is considered a ‘narrow analysis’ which includes only the costs accruing within the healthcare sector, while the latter represents a ‘broad analysis’ that accounts for all resource implications in all sectors of the economy. After an investigation into various types of costs, a ‘limited societal perspective’ is suggested to be more appropriate than either of the two ‘extreme perspectives’. The chapter continues with a discussion of the cost per quality-adjusted life year (QALY) threshold and explains the difference between a demand side- versus a supply-side approach to determining a threshold value for a QALY.

Quality of Life and Resource Allocation

1988 ◽  
Vol 23 ◽  
pp. 33-55 ◽  
Author(s):  
Michael Lockwood
Keyword(s):  
Quality Of Life ◽  
Resource Allocation ◽  
Quality Adjusted Life Year ◽  
Medical Resources ◽  
Medical Vocabulary ◽  
Quality Adjusted Life

A new word has recently entered the British medical vocabulary. What it stands for is neither a disease nor a cure. At least, it is not a cure for a disease in the medical sense. But it could, perhaps, be thought of as an intended cure for a medicosociological disease: namely that of haphazard or otherwise ethically inappropriate allocation of scarce medical resources. What I have in mind is the term ‘QALY’, which is an acronym standing for quality adjusted life year. Just what this means and what it is intended to do I shall explain in due course. Let me first, however, set the scene.

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