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Are Methods for Estimating QALYs in Cost-Effectiveness Analyses Improving?

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  • Peter J. Neumann
  • Darren E. Zinner
  • Janice C. Wright

Abstract

Objectives. The objectives of this study were to examine variations in the methods used by researchers to estimate QALYs in published cost-effectiveness analyses, and to investigate whether the methods have improved over time. Data and methods. Using a MEDLINE search, the authors identified 86 original cost-effectiveness analyses, pub lished between 1975 and 1995, that used QALYs as the measure of effectiveness. For each study, they recorded the health-state classification system, the source of the preference weights, the measurement technique, and the discount rate. The methods used were compared with the recommendations of the U.S. Panel on Cost-Effective ness in Health and Medicine. Results. Only 20% of the studies used "generic" health- state classification systems (e.g., health utilities index); 21% relied on community- based weights; 40% used formal measurement techniques (e.g., time-tradeoff method); and 88% discounted both future costs and QALYs. There was little evidence that methods had improved over time. Conclusions. The results illustrate extensive variation in the construction of QALYs in cost-effectiveness analyses and reveal that most studies have not adhered to practices now recommended by leaders in the field. There is a need for more methodologic rigor and consistency if the results of such studies are to be compared and used for purposes of allocating resources. Key words: QALYs; quality-adjusted; cost-effectiveness analysis. (Med Decis Making 1997;17: 402-408)

Suggested Citation

  • Peter J. Neumann & Darren E. Zinner & Janice C. Wright, 1997. "Are Methods for Estimating QALYs in Cost-Effectiveness Analyses Improving?," Medical Decision Making, , vol. 17(4), pages 402-408, October.
    • Handle: RePEc:sae:medema:v:17:y:1997:i:4:p:402-408
    DOI: 10.1177/0272989X9701700405
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    References listed on IDEAS

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    1. Drummond, Michael & Torrance, George & Mason, James, 1993. "Cost-effectiveness league tables: More harm than good?," Social Science & Medicine, Elsevier, vol. 37(1), pages 33-40, July.
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    1. K. Cooper & S. Brailsford & R. Davies & J. Raftery, 2006. "A review of health care models for coronary heart disease interventions," Health Care Management Science, Springer, vol. 9(4), pages 311-324, November.
    2. Trude Arnesen & Mari Trommald, 2005. "Are QALYs based on time trade‐off comparable? – A systematic review of TTO methodologies," Health Economics, John Wiley & Sons, Ltd., vol. 14(1), pages 39-53, January.
    3. K Cooper & S C Brailsford & R Davies, 2007. "Choice of modelling technique for evaluating health care interventions," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 58(2), pages 168-176, February.
    4. Linda D. MacKeigan & Amiram Gafni & Bernie J. O'Brien, 2003. "Double discounting of QALYs," Health Economics, John Wiley & Sons, Ltd., vol. 12(2), pages 165-169, February.
    5. Gerard, Karen & Smoker, Irenie & Seymour, Janelle, 1999. "Raising the quality of cost-utility analyses: lessons learnt and still to learn," Health Policy, Elsevier, vol. 46(3), pages 217-238, March.

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