Quality-adjusted life-years

The most commonly used measure of utility in the health economics literature is the quality-adjusted life year (QALY), which weights longevity by life quality. The most commonly used preference-weighted measure of health-related quality of life in the UK is the EuroQol or EQ-5D (EuroQpl Group, 1990), but there are various other such measures. Utility scores can now be obtained from the 36-item Short Form (SF-36) quality-of-life scale, for example. Also in use are healthy-year equivalents (Mehrez and Gafni, 1989) and disability-adjusted life years (WHO, 2000), although both these measures are different in aim and construction from the QALY and are used less often in evaluations. 

MehrezA, GafniA (1989). Quality adjusted life years, utility theory, and healthy years equivalents. Med Decision Making, 142-9. 

Only two randomized, controlled trials have been completed, and neither provides anything like compelling data (Table 2.6). Chouinard and Albright (1997) conducted a unique evaluation of a subset of patients from a previously conducted clinical trial. Subjects were categorized and profiled at baseline and end point according to clinical severity, and a group of psychiatric nurses were asked to rate various aspects of likely outcome and quality of life to each profile (mild, moderate or severe symptoms). Health state utilities were then calculated risperidone was found to provide more than double the number of quality-adjusted life years compared with haloperidol. Csernansky and Okamoto (1999) conducted a rather more conventional trial, but included no economic analyses. However, they did find that the use of risperidone substantially reduced relapse rates compared with haloperidol—an outcome likely to have a positive impact on cost-effectiveness. 

Various forms of psychotherapy are regarded as effective interventions in mild to moderate depression, but studies comparing the economics of psychotherapy and pharmacotherapy are few (Rosenbaum and Hylan, 1999). One study found that the total health-care costs for patients who received psychotherapy were no different from those for patients who received an antidepressant. However, no efficacy measure was used (Edgell and Hylan, 1997). A randomized, prospective study which evaluated the treatment of depression with nortriptyline, interpersonal therapy or treatment as usual, with outcomes expressed in quality-adjusted life years, found that nortriptyline but not interpersonal therapy was a cost-effective alternative to treatment as usual (Lave et al, 1998). 

Cost-utility analysis is similar to cost-efFectiveness analysis in approach, but uses utility as the outcome measure. The utility value is a measure that combines preferences for and values of the overall effect of an intervention on survival, physical and mental health, and social function. Utility is combined with estimates of length of life to provide an assessment of quality-adjusted life years (QALYs). As in cost-efFectiveness analysis, incremental cost-utility ratios are calculated to estimate the cost of producing one extra QALY. 

Neumann et at (1999) Quality-adjusted life years 1997 US dollars 483 0.015... 

One study used quality-adjusted life years to capture the range of health-related dimensions that may affect the quality of life of patients. This measure also provides an estimate of the value or preferences for changes in health status (Neumann et al, 1999). The study used the Health Utility Index Mark II in a sample of patients and carers, which is a generic measure of the value of health-related quality of life. However, it is clear that further research is needed to explore (a) the key determinants or dimensions of quality of life that are important to people with dementia and their carers (b) whether existing instmments to measure and value health-related quality of life are able to detect differences in quality of life that are important to people with cognitive disability and their carers and (c) whether the assessment and... 

QALY (Quality adjusted life year) HALY (health adjusted life year)... 

Cost-utility analysis Dollars Quality-adjusted life-years (QALYs)... 

The CUA is a form of cost-effectiveness analysis in which the health outcomes are measured in terms of quality-adjusted life-years (QALYs) gained. The QALY is a measure that associates quantity of life (e.g. survival data and life... 

Thus, it appears that the current practice by analysts to use AWP results in a value for the cost of a drug that is substantially in excess of marginal cost. If the estimated incremental cost per quality-adjusted life year (QALY) using AWP is very low or very high relative to benchmarks of acceptable ratios, or if drug therapy is dominated by another comparator, treatment of cost would not matter in the decision about whether to cover a drug under an insurance plan or include it on the formulary. But over a sizeable range of values reasonably close to the benchmark, the cost estimate used should affect the decision about acceptability of the product. So it seems appropriate to explore the conceptual framework that should be used for such analysis in more detail. 

Economic evaluation compares costs and consequences of alternative health care treatments or programs (Drummond et al. 2005). In one form of economic evaluation, cost-benefit analysis, all costs and consequences are valued in monetary terms. However, in health care it is much more common to use cost-effectiveness analysis, where the difference in cost between alternatives is compared with the difference in outcomes measured in units such as life years gained or quality-adjusted life years (QALYs) gained. 

These preferences for the different disease states, expressed as numbers, are called utilities, and are used to qualitv-adjust or to weight the additional years of survival. The result is a quality-adjusted life-year (QALY) gained. Quality-adjusted life-years gained are also used frequently as the denominator of a cost-effectiveness ratio, as in costs per QALYs gained. 

Establishing the value of a new pharmaceutical can be done through a cost-effectiveness ratio, where the costs are compared with currently accepted therapy and the effect is expressed in natural units such as life-years gained or disability-free days. A cost-utility analysis uses QALYs as the expression of the drug s effect, which is a measure that incorporates all the outcomes as well as all the costs of the drug treatment. Such a broad-based measure captures how much improved the patient s life becomes as a result of the treatment and at what cost. Quality-adjusted life-years can be viewed as life-years gained,... 

Torrance, G.W., Feeny, D. Utilities and quality-adjusted life years. Ini. J. TechnoL Assess. Health Care 5, 559-575, 1989. 

Tousignant P, Cosio MG, Levy RD, Groome PA. Quality adjusted life years added by treatment of obstructive sleep apnea. Sleep 1994 17(1 ) 52—60. 

Cost-utility analysis is used when quality of fife is the most important outcome being examined. This is common in disease states in which how one feels or what one can do is more important than a clinical laboratory value or economic outcome (e.g., chronic diseases such as heart disease, diabetes, arthritis, cancer, or HIV/AIDS). Cost-utility analyses compare the direct and indirect costs of an intervention with some measurable level of humanistic outcome, such quality of life or level of satisfaction. The direct and indirect costs of treatment alternatives again are expressed in monetary terms. The humanistic outcomes associated with each intervention can be expressed as an SF-12 or SF-36 health survey score for quality of life (Ware, 1997), as a satisfaction survey score (Mac-Keigan and Larson, 1989), or as quality-adjusted life-years (QALYs). QALYs represent the number of full years at full health that are valued equivalently with... 

Cost per hospital stay, proportion of patients going back to work, cost per gained quality-adjusted life years Mortality and disability... 

So now, here are the final diabetes statistics from the Centers for Disease Control and Prevention in the United States, which I quote directly from the report in the Journal of the American Medical Association If an individual is diagnosed at age 40 years, men will lose 11.6 life-years and 18.6 quality-adjusted life-years and women will lose 14.3 life-years and 22.0 quality-adjusted life-years. Those extra years of life and quality of life are well worth working for. 

Cost-utility analysis is concerned with comparisons between programmes, e.g. an antenatal drug treatment which saves a young life or a hip replacement operation which improves mobility in a man of 60 years. Such differing outcomes can be placed on the same basis for comparison by computing quality-adjusted life years (see below). 

Everyone is familiar with the measurement of the benefit of treatment in saving or extending life, i.e. life expectancy the measure is the quantity of life (in years). But it is evident that life may be extended and yet have a low quality, even to the point that it is not worth having at all. It is therefore useful to have a unit of health measurement that combines the quality of life with its quality to allow individual and sodal decisions to be made on a sounder basis than mere intuition. To meet this need economists have developed the quality-adjusted-life-year (QALY) estimations of years of life expectancy are modified according to estimations of quality of life. 

Within the scope of clinical studies, valuable economic information on medical procedures can (and should) be obtained. Today, economic assessment assumes a special role in clinical studies, and because of its complex stratification and the general need for rationalization, e. g. in terms of the cost/benefit analysis, it is likely to become more and more important. The quality-adjusted life year (G.W. Torrance, 1987) should be included in the assessment, (s. p. 850)... 

Orthopedics has recognized the importance of measuring outcomes in terms of quality-adjusted life-years instead of length of implant survival.Similarly, pharmacy must implement software documentation solutions that facilitate outcomes monitoring beyond cost savings. Software is needed with the ability to calculate, in a cost-benefit analysis, the clinical impact of pharmacist interventions as they affect therapeutic, financial, and humanistic outcomes. The current array of products could be better integrated into documentation software to facilitate tabulation of these data. With the power of the Internet to manipulate data in a dynamic database, it would even be possible for hospitals to compare their outcomes on a local, regional, or national basis. Furthermore, the database could... 

The CUA is a form of cost-effectiveness analysis in which the health outcomes are measured in terms of quality-adjusted life-years (QALYs) gained. The QALY is a measure that associates quantity of life (for example survival data and life expectancy) with quality of life, by amalgamating them into a single index. One QALY is equal to a year of full life quality. Because of its universal denominator which allows comparisons across divergent areas, CUA is a tool that can (in theory) be used by policy makers... 

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