PharmacoEconomics

, Volume 29, Issue 8, pp 673–685

Using QALYs in Cancer

A Review of the Methodological Limitations
  • Martina Garau
  • Koonal K. Shah
  • Anne R. Mason
  • Qing Wang
  • Adrian Towse
  • Michael F. Drummond
Review Article

DOI: 10.2165/11588250-000000000-00000

Cite this article as:
Garau, M., Shah, K.K., Mason, A.R. et al. Pharmacoeconomics (2011) 29: 673. doi:10.2165/11588250-000000000-00000

Abstract

The objective of this paper is to examine how well the QALY captures the health gains generated by cancer treatments, with particular focus on the methods for constructing QALYs preferred by the UK National Institute for Health and Clinical Excellence (NICE). Data were obtained using a keyword search of the MEDLINE database and a hand search of articles written by leading researchers in the subject area (with follow up of the references in these articles). Key arguments were discussed and developed at an oncology workshop in September 2009 at the Office of Health Economics.

Three key issues emerged. First, the EQ-5D, NICE’s preferred measure of health-related quality of life (QOL) in adults, has been found to be relatively insensitive to changes in health status of cancer patients. Second, the time trade-off, NICEs preferred technique for estimating the values of health states, involves making assumptions that are likely to be violated in end-of-life scenarios. Third, the practice of using valuations of members of the general population, as recommended by NICE, is problematic because such individuals typically display a misunderstanding of what it is really like for patients to live with cancer.

Because of the way in which it is constructed, the QALY shows important limitations in terms of its ability to accurately capture the value of the health gains deemed important by cancer patients. A research agenda for addressing these limitations is proposed.

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  • Martina Garau
    • 1
  • Koonal K. Shah
    • 1
  • Anne R. Mason
    • 2
  • Qing Wang
    • 3
  • Adrian Towse
    • 1
  • Michael F. Drummond
    • 2
  1. 1.Office of Health EconomicsLondonUK
  2. 2.Centre for Health EconomicsUniversity of YorkYorkUK
  3. 3.Bristol-Myers SquibbUxbridgeUK

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