Health economic assessments of anticancer agents: A comparison of assessment technologies applied to end-stage cancer.

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e16623 Background: The availability of newer therapeutic options to treat patients with cancer often depend on falling at or below economic value thresholds; namely, dollars per quality adjusted life years (QALY). The issue is that for patients with end stage cancer, these economic values (Cost/ QALY) tend to infinity as life expectancy diminishes. We compare and contrast the application and implications of life years gained (LYG) and Quality Adjusted Life Years (QALYs), when overall survival is less than one year for end stage cancer. Methods: We conducted a systematic search of published and publically available literature using Medline (1980-2010) and Google for: “End Stage Cancer (ESC),” “Life Years Gained (LYG),” and “Quality Adjusted Life Years (QALYs)” and their combinations. Extracted citations were reviewed by two researchers for relevance. Results: The Medline search yielded 7,488 citations for ESC, 2,920 for LYG and 7,138 for QALYs, and 3 and 20 for the combinations of ESC, LYG and QALY. The Google search yield 5 citations, all more on-target to the study aims. LYG is a mortality measure quantifying the incremental net benefit (INB) of two treatment strategies in terms of changes in life expectancy while QALYs weigh life expectancy by a value between 0 (death) and 1 (perfect health). In reviewing quality-weighting survival time, the literature found QALYs were biased with age, disease and how those weights were assessed. Social and personal aversion to risk also sway thQALY measure. LYG lack those design biases, although LYG cannot differentiate safety profiles among anticancer agents. The cancer literature with LYG and QALY did not differentiate between their application to end-stage versus earlier stage, missing economic inefficiencies and a violation of the fundamental axiom of health economic assessments, life is a ‘good’ thing. Conclusions: LYG, a mortality measure, is better suited for end stage cancer than QALY because even small changes in utility weights result in inefficiencies which can under or overestimate the QALY measure and as survival diminishes standard economic theory would predict that any resource use becomes unaffordable.