Quality-adjusted life year
A quality- adjusted life (English quality adjusted life year or QALY ) is a measure for the evaluation of a year of life in relation to health. A QALY of 1 means a year full of health, while a QALY of 0 corresponds to a decease. QALY is therefore a benefit for life ( - sjahr ). The QALY is the most widely used measure in the health economic evaluation.
The aim of QALYs
The aim of this measure of health services research is to convert the subjective good health in a measurable index to conduct cost-benefit analyzes. In contrast to simple cost - cost or cost - effectiveness analysis results of different dimensions together QALY medical output and thus allows, in contrast to the simpler approaches also the comparison of treatments on various diagnoses of time (inter indication comparison). This makes it theoretically possible to make a transparent rationing decision: a medical procedure is paid as long as it does not exceed a limit of x EUR / QALY. Such a threshold has been nowhere explicitly been set, but will work with intervals. An estimate assumes that the threshold of the British NICE ( National Institute for Health and Clinical Excellence ) is between £ 20,000 and £ 30,000. However, measures will be approved again and again, the cost per QALY are well above this value.
Derivation of the measure
A possible derivation of QALY is made possible by the so-called Time -Trade -Off: " How many years of my life I 'm willing to make, if I can live without any health restrictions for always. " The remaining years meet the personal QALY. In this case, the participant is given the choice between a state with reduced quality of life - put x in perfect health and subsequent death for the rest of his statistical life expectancy and a period - no specific diagnosis. The time x is varied until the respondent is indifferent between the two states.
The QALY is an extra - welfaristisches concept; it is only a maximization within the health care sought, whether similar effects can be achieved by other measures to lower costs, is not questioned. For such a cost-benefit analysis concepts have been developed to assess the health benefits in monetary terms. The determination of these values , however, is more problematic than the calculation of QALYs, so that these concepts have not been enforced.
Criticism of the QALY concept
The QALY is an approximation for the uniform assessment of health services in a resource use is efficiently represented in the health sector. However, although the problem of comparison of various indications and the conflict of interest between economic efficiency and financial sustainability are resolved, the code is not without controversy. There are, for a methodological arguments that cast doubt on the QALYs and other ethical opinions that criticize the concept.
For the methodological counter arguments heard that despite a consistent use of the time trade -off instrument, various studies lead to very different results on the estimation of the quality of life effects in the subjects. The scenarios presented in which they are to provide information about how much life they would be willing to give in order to receive full quality of life in return, are not identical. This leads to a conditional comparison only. In addition, minor changes in the quality of life are currently detect not yet measurable. Therefore, the QALY could not be calculated correctly, thus leading to conceal the actual preferences of patients.
In addition, the utility increase of 0.1 QALYs at a very sick patient and an almost healthy people - be equated - already may have a quality of life of 0.9 QALYs. According to the law of marginal utility removable however it can be assumed that a small improvement in health is more rated better, the worse the general condition was before. This aspect is not taken into account in the QALY concept. Moreover, there is here an ethical point of the charge of discrimination against the sick or disabled. Older people are due to the inclusion of life expectancy also disadvantaged in the QALY calculation. You can because of their advanced age only less QALYs to gain than younger people.