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Qaly league tables: Handle with care

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  • Karen Gerard
  • Gavin Mooney

Abstract

This paper examines some of the difficulties in using QALY league tables in priority setting. Such tables sometimes are seen as being ‘the’ way to prioritise in health care and in particular, at present, with respect to priority setting among purchasers in the UK NHS. However the paper highlights the fact that the base on which such tables is built is small—relatively few studies in the English language using CUA have been conducted anywhere. Further, four issues which require handling with care are set out: (i) the relevant measure of cost in QALY league tables has to be restricted to health service resource use; (ii) the relevant measure of benefit in QALY league tables is clearly restricted to QALYs, thereby the utility of health gains and indeed the maximisation of the utility of health gains; (iii) in incorporating the results of CUA studies into QALY league tables there is a need for greater clarification on what the margin constitutes; and (iv) those who might use CUA results in QALY league tables need to ascertain whether the original context of the study will allow the results to be transferred to the local context of the decision maker. The paper suggests that there is a need to be quite clear what goal QALY league tables serve. The authors argue that the only legitimate (and clearly important) goal of QALY league tables is the maximisation of the utility of health gains within a health service budget. The thinking underlying QALY league tables, adjusted to take account of the caveats in this paper, is the key to rational priority setting at a local level. It is this thinking that is to be emphasised rather than the use of ‘imported’ league tables or the use of results from CUA studies conducted elsewhere in the country or indeed in other countries. If results from elsewhere are to be used, the study context has to be examined carefully to establish the extent of its relevance to the local circumstances facing the purchasing authority.

Suggested Citation

  • Karen Gerard & Gavin Mooney, 1993. "Qaly league tables: Handle with care," Health Economics, John Wiley & Sons, Ltd., vol. 2(1), pages 59-64, April.
    • Handle: RePEc:wly:hlthec:v:2:y:1993:i:1:p:59-64
    DOI: 10.1002/hec.4730020108
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    References listed on IDEAS

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    1. Gerard, Karen, 1992. "Cost-utility in practice: A policy maker's guide to the state of the art," Health Policy, Elsevier, vol. 21(3), pages 249-279, July.
    2. Loomes, Graham & McKenzie, Lynda, 1989. "The use of QALYs in health care decision making," Social Science & Medicine, Elsevier, vol. 28(4), pages 299-308, January.
    3. Maynard, Alan, 1991. "Developing the Health Care Market," Economic Journal, Royal Economic Society, vol. 101(408), pages 1277-1286, September.
    4. Torrance, George W., 1986. "Measurement of health state utilities for economic appraisal : A review," Journal of Health Economics, Elsevier, vol. 5(1), pages 1-30, March.
    5. S Birch & A Gafni, 1991. "Cost Effectiveness/Utility Analyses: Do Current Decision Rules Lead us to Where We Want to Be?," Centre for Health Economics and Policy Analysis Working Paper Series 1991-06, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    6. Bryan, Stirling & Parkin, David & Donaldson, Cam, 1991. "Chiropody and the QALY: a case study in assigning categories of disability and distress to patients," Health Policy, Elsevier, vol. 18(2), pages 169-185, July.
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