Is a QALY still a QALY at the end of life?

► Health outcomes for patients at the end of life are difficult to measure and value. ► Some argue that the QALY is not an appropriate outcome measure at the end of life. ► The arguments against the QALY lack empirical or theoretical foundation. ► The strengths of the QALY make it suitable for use i...

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Bibliographic Details
Published in:Journal of health economics 2012-05, Vol.31 (3), p.521-527
Main Author: Round, Jeff
Format: Article
Language:English
Subjects:
Abandoned
Abandonment
Adjustment
Clinical outcomes
Cost-Benefit Analysis
Data collection
Death
Economics
Empirical analysis
Empirical Research
End of life
End of life care
End of life decisions
Ethics
Evidence-Based Practice
Health
Health administration
Health Care Rationing
Health inequality
Humans
Medical treatment
Outcome Assessment (Health Care) - methods
Palliative care
Palliative Care - economics
Quality adjusted life years
Quality of Life
Resource allocation
Studies
Survival
Survival analysis
Terminal Care - economics
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Summary:► Health outcomes for patients at the end of life are difficult to measure and value. ► Some argue that the QALY is not an appropriate outcome measure at the end of life. ► The arguments against the QALY lack empirical or theoretical foundation. ► The strengths of the QALY make it suitable for use in end of life care. ► Improved methods for measuring and valuing health states would improve QALY estimation. Recent research into end of life and palliative care has focused on the development of a replacement for the quality adjusted life year (QALY) as an outcome measure. Reasons given range from the lack of anticipated survival benefit from treatment to the inappropriateness of death as an anchor for valuing health states, or the increased value of time to the individual at the end of life. The Palliative Care Yardstick, has been proposed as an alternative. In this paper, I argue that the QALY should not be abandoned as an outcome measure in end of life and palliative care populations and suggest possible methods for generating empirical data to support or refute this. I show why the arguments made for replacement of the QALY are not supported by current evidence and how in some cases the abandonment of the QALY framework would lead to an unjustifiable inequitable distribution of resources.
ISSN:0167-6296
1879-1646
DOI:10.1016/j.jhealeco.2012.01.006