QALYs and their use by the health service

Despite considerable progress and achievements in health care over the last century, we still cannot give every ill person as full a treatment as possible. With limited resources, decisions have to be made to determine priorities in the health care system. These decisions should be based on both costs of resource inputs and on the health outcome for the patients involved. However, there is little emphasis on outcome data in present decisions and its importance and usefulness needs to be highlighted. In a joint project between the University of York and the North Western Regional Health Authority (NWRHA), one measure of health outcome, the quality-adjusted-life-year (QALY) was combined with cost data to provide a new criterion for use in determining resource allocation. The NWRHA found this cost/QALY data to be a useful adjunct to their decision-making and they will require details of both resource inputs and of health outcome to be given in subsequent bids. It is hoped that with the further development of the QALY-type measurement, it will be easier to include such information in the decision-making process and those concerned will be reminded that the quality of life is a factor that should not be ignored. In this paper the background to the project and the methods used are described. This is followed by a discussion of the QALY results in terms of their usefulness to a health authority, and in the context of some shortcomings that have yet to be resolved.