Abstract
BackgroundThe Quality-Adjusted Life Year (QALY) is internationally recognized as standard metric of health outcomes in cost-effectiveness analyses (CEAs) in healthcare. The ongoing debate concerning the appropriateness of its use for decision-making in palliative care has been recently mapped in a review. The aim was to report on and draw conclusions from two expert meetings that reflected on earlier mapped issues in order to reach consensus, and to advise on the QALY’s future use in palliative care.MethodsA nominal group approach was used. In order to facilitate group decision making, three statements regarding the use of the QALY in palliative care were discussed in a structured way. Two groups of international policymakers, healthcare professionals and researchers participated. Data were analysed qualitatively using inductive coding.Results1) Most experts agreed that the recommended measurement tool for the QALYs ‘Q’ component, the EuroQol-5D (EQ-5D), is inappropriate for palliative care. A more sensitive tool, which might be based on the capabilities approach, could be used or developed. 2) Valuation of time should be incorporated in the ‘Q’ part, leaving the linear clock time in the ‘LY’ component. 3) Most experts agreed that the QALY, in its current shape, is not suitable for palliative care.Conclusions1) Although the EQ-5D does not suffice, a generic tool is needed for the QALY. As long as no suitable alternative is available, other tools can be used besides or serve as basis for the EQ-5D because of issues in conceptual overlap. 2) Future research should further investigate the valuation of time issue, and how best to integrate it in the ‘Q’ component. 3) A generic outcome measure of effectiveness is essential to justly allocate healthcare resources. However, experts emphasized, the QALY is and should be one of multiple criteria for choices in the healthcare insurance package.
Highlights
The Quality-Adjusted Life Year (QALY) is internationally recognized as standard metric of health outcomes in cost-effectiveness analyses (CEAs) in healthcare
3) Most experts agreed that the QALY, in its current shape, is not suitable for palliative care
1) the EQ-5D does not suffice, a generic tool is needed for the QALY
Summary
The Quality-Adjusted Life Year (QALY) is internationally recognized as standard metric of health outcomes in cost-effectiveness analyses (CEAs) in healthcare. Healthcare costs are rising due to expanding treatment options, the aging of the baby boomers, and increased longevity [1,2,3] This increasingly raises questions as to which medical interventions should be financed and which not [4,5,6]. Cost-effectiveness is not the only basis for allocation decisions; in the Netherlands for example, it is one of four criteria in the insurance coverage process [7] The standard outcome metric in costeffectiveness analysis to inform decisions on resource allocation in health care is the Quality-Adjusted Life Year (QALY). Societies can determine the willingness to pay for a QALY gained In this way, the relative costs and outcomes of interventions can be compared.
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