Abstract
Decisions have to be made about allocating health resources. Currently the best economic evaluation method for doing this is cost-utility analysis. This compares the costs of different procedures with their outcomes measured in "utility based" units--that is, units that relate to a person's level of wellbeing. The most commonly used unit is the quality adjusted life year (QALY). QALYs are calculated by estimating the total life years gained from a procedure and weighting each year to reflect the quality of life in that year. To compare outcomes of different programmes the Rosser index is one measure that is widely used to assign quality of life scores to patients. Combined with a measure of life years gained from a procedure, this enables QALYs to be calculated and procedures ranked according to cost per QALY gained. In this article Ray Robinson explains the measures used and discusses how QALY league tables can be used to guide decisions on resource allocation.
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- Bergner M., Bobbitt R. A., Carter W. B., Gilson B. S. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981 Aug;19(8):787–805. doi: 10.1097/00005650-198108000-00001. [DOI] [PubMed] [Google Scholar]
- Brazier J. E., Harper R., Jones N. M., O'Cathain A., Thomas K. J., Usherwood T., Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992 Jul 18;305(6846):160–164. doi: 10.1136/bmj.305.6846.160. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Carr-Hill R. A. Allocating resources to health care: is the QALY (Quality Adjusted Life Year) a technical solution to a political problem? Int J Health Serv. 1991;21(2):351–363. doi: 10.2190/HPLM-EGXV-BWKY-5XBN. [DOI] [PubMed] [Google Scholar]
- Carr-Hill R. A. Assumptions of the QALY procedure. Soc Sci Med. 1989;29(3):469–477. doi: 10.1016/0277-9536(89)90296-7. [DOI] [PubMed] [Google Scholar]
- Gerard K., Mooney G. QALY league tables: handle with care. Health Econ. 1993 Apr;2(1):59–64. doi: 10.1002/hec.4730020108. [DOI] [PubMed] [Google Scholar]
- Gudex C., Williams A., Jourdan M., Mason R., Maynard J., O'Flynn R., Rendall M. Prioritising waiting lists. Health Trends. 1990;22(3):103–108. [PubMed] [Google Scholar]
- Loomes G., McKenzie L. The use of QALYs in health care decision making. Soc Sci Med. 1989;28(4):299–308. doi: 10.1016/0277-9536(89)90030-0. [DOI] [PubMed] [Google Scholar]
- Mason J., Drummond M., Torrance G. Some guidelines on the use of cost effectiveness league tables. BMJ. 1993 Feb 27;306(6877):570–572. doi: 10.1136/bmj.306.6877.570. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mehrez A., Gafni A. Quality-adjusted life years, utility theory, and healthy-years equivalents. Med Decis Making. 1989 Apr-Jun;9(2):142–149. doi: 10.1177/0272989X8900900209. [DOI] [PubMed] [Google Scholar]
- O'Brien B. J., Banner N. R., Gibson S., Yacoub M. H. The Nottingham Health Profile as a measure of quality of life following combined heart and lung transplantation. J Epidemiol Community Health. 1988 Sep;42(3):232–234. doi: 10.1136/jech.42.3.232. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wagstaff A. QALYs and the equity-efficiency trade-off. J Health Econ. 1991 May;10(1):21–41. doi: 10.1016/0167-6296(91)90015-f. [DOI] [PubMed] [Google Scholar]
- Williams A. Economics of coronary artery bypass grafting. Br Med J (Clin Res Ed) 1985 Aug 3;291(6491):326–329. doi: 10.1136/bmj.291.6491.326. [DOI] [PMC free article] [PubMed] [Google Scholar]

