Using Quality-Adjusted Life-Years in Cost-Effectiveness Analyses: Do Not Throw Out the Baby or the Bathwater.

Abstract

Weneed ametric to understand the value of cancer treatments—this issue is not under debate. In recent months, different professional societies have produced tools to attempt to assess value, but they have avoided the use of cost-effectiveness studies. The science of cost effectiveness has come under attack in recent years, with specific questions regarding the use of qualityadjusted life-years (QALYs). Although costeffectiveness techniques are used in many countries to make decisions regarding coverage of health care interventions, some stakeholders have challenged the appropriateness and accuracy of this science. Riesco-Martinez et al have demonstrated how to perform a well-balanced costeffectiveness study analyzing different treatment sequences for metastatic colon cancer. They did this from the perspective of a Canadian payer, and in their analysis they included the use of QALYs. They should be commended for this analysis,andtheresultsmaybeusedtoguide coverage decisions in Canada. However, in many parts of the world, particularly the United States, there is major opposition to the use of cost-effectiveness analyses, particularly the use of QALYs. When the United States Congress developed the Patient-Centered Outcomes Research Institute, it explicitly forbade the use of QALYS in cost-effectiveness research. Whydo somany stakeholders involved in health care have such visceral opposition to cost-effectiveness research and the use of QALYs? To understand this, we must first understand the definition of a QALY?