Viney R, Savage E, Hall J; Health Technology Assessment International. Meeting (3rd : 2006 : Adelaide, S. Aust.).
Handb Health Technol Assess. 2006; 3: 113.
CHERE, University of Technology, Sydney, PO Box 123, Broadway, Sydney, NSW, Australia, 2007
Background: Economic evaluation is used increasingly to answer questions about which health services should be provided by government on a subsidised basis. This has lead to an increased requirement for comparability across interventions and diseases, and the emergence of cost-utility analysis (CUA) as the dominant evaluation tool, in which interventions are compared in terms of cost per quality adjusted life year (QALY). Methods: In this paper we critique commonly used approaches to generate QALYs from clinical trial data. We present simulation results to show the potential distortions that result from using the QALY approach if the restrictions on individual preferences are not valid. Results: QALYs are frequently generated by ad hoc methods, including: transformation of clinical data and or quality of life data into descriptive scenarios, which are then evaluated using a range of different methods, which often have a limited theoretical basis; or transformations of clinical data into multi-attribute utility space allowing the application of published utility weights (or QALY weights). Even where multi-attribute utility instruments are used to directly measure quality of life in trials, there are problems with the interpretation of the results in terms of QALYs, because of the need to extrapolate beyond the trial period. Further the underpinnings of QALYs in economic theory require acceptance of unrealistic restrictions on individual preferences. Conclusions: There remains considerable debate over the methods of generating QALY estimates, particularly given that most clinical trials measure intermediate endpoints
Publication Types:
Keywords:
- Clinical Trials as Topic
- Decision Making
- Quality-Adjusted Life Years
- methods
- organization & administration
- hsrmtgs
UI: 103724879
From Meeting Abstracts