Abstract
Quality-Adjusted Life-Years (QALYs) are central to healthcare decision-making in Britain and abroad, yet their history is poorly understood. In this paper, we argue that a more in-depth and political history of the QALY is needed to allow a critical evaluation of its current dominance. Exploiting rich data from archives and 44 semi-structured interviews conducted between 2015 and 2018, we employ Multiple Streams Analysis to construct a complex and dynamic picture of how the idea of QALYs emerged and was adopted within UK health policy. Through its historical and political approach, the paper illuminates the relative roles in the policy-making process of experts (especially economists) and politicians as ‘entrepreneurs’ in the development of new ideas; how these were influenced by negotiation within established and emerging institutional structures; and the role of serendipity and crisis.
Highlights
The Quality-Adjusted Life-Years (QALYs) measurement – a tool developed to evaluate the cost-effectiveness of treatments – is central to healthcare decision-making in Britain – where it forms the basis of the work of the National Institute for Health and Care Excellence (NICE) – and in many other countries
I don't think there was ever ... any idea that this was going to be the way that they were going to make decisions. (A8). It is this budding relationship that eventually led some economists, medical professionals and NHS managers to setting-up what may be termed the precursors of NICE, the Development and Evaluation Committees (DECs) from 1991, in which QALYs were operationalised, bringing together “a group of the health authorities trying to make decisions on what technologies, in the widest sense, to invest in their patch” (Ron Akehurst, witness seminar organised on 27 October 2017 on the development of health economics)
This paper has constructed a history of the development and implementation of the QALY concept and associated tools within UK health policy, mobilising Multiple Streams Analysis
Summary
It is variously referred to as an ‘index’, ‘tool’ or ‘measurement’ It is a widespread concept, the history of the QALY remains obscured and/or often simplified. What is needed is a more rigorous history of the QALY, emphasising the political economy of its emergence and subsequent adoption within health policy and decision-making. This is necessary to support debates on whether QALYs are the best available tools for decision-making and how they might contribute to, or hinder, the goal of equity in healthcare (Knapp, 2015). We conclude by discussing the importance of critical historical research for effective health policy development
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
