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Using QALYs in Cancer

A Review of the Methodological Limitations


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.

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Table I


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The authors are grateful for the contributions of Claire Devaney, Nancy Devlin, the anonymous reviewers and participants at the Office of Health Economics oncology workshop in September 2009.

This paper is based on part of a consulting project commissioned and funded by the Pharmaceutical Oncology Initiative (POI) group. The material presented in this paper is independent of the funders. There are no conflicts of interest to declare.

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Correspondence to Koonal K. Shah.

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Garau, M., Shah, K.K., Mason, A.R. et al. Using QALYs in Cancer. Pharmacoeconomics 29, 673–685 (2011).

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  • Health Gain
  • Health State Valuation
  • Describe Health State
  • Remain Life Expectancy
  • Unique Health State