The QALY toolkit

QALYs (quality adjusted life years) represent a powerful addition to the range of evaluative techniques for use in assessing the impact of health care. In the past, such benefits have been portrayed in terms of their contribution to life expectancy. The ability to adjust for quality of life is an important step which permits comparisons to be made between specific forms of intervention, and between competing programmes of health care. The measurement of quality of life is fundamental to the calculation of QALYs and is achieved, in this case, by using an index first described by Rachel Rosser (now Professor of Psychiatry, Middlesex Hospital, London). This “toolkit” brings together all the relevant background information on measuring QALYs. The Paper sets out the background to the Rosser index, including both the descriptive classification of disability/distress states and their associated valuations. It also presents examples of the methods which have been used to compute QALYs – by reprocessing published data and consulting specialist reference groups. A self-completed questionnaire which yields Rosser ratings has been developed by the York QALY team for use in survey settings. The questionnaire is included as an Appendix, together with instructions in encoding response data. Policy choice has to be informed by data about the costs and outcomes of therapies and programmes competing for scarce and limited resources. This QALY toolkit, in conjunction with cost data, will enable policy makers to identify cost-effective policies and ensure choices give good value for money to public and private sector health care systems.