The Quality Adjusted Life Years (QALY) approach to deciding which treatments are available on health services - used by the UK and generating much interest across Europe - is dangerously flawed and should be abandoned, according a European Commission funded research project.
The results of the project, announced 25th January at a Brussels conference on health outcomes, highlight huge failings in the way some Health Technology Assessment (HTA) agencies, notably the UK's National Institute for Health and Clinical Excellence (NICE), recommend which treatments be made available on health services, and warns against this system being adopted across Europe.
HTA agencies are charged with recommending whether new treatments are publicly funded.
NICE uses QALY - an economic theory which mathematically weighs number of life years by quality of life provided by different treatments. Based on this calculation, decisions are made about whether treatments are offered by the National Health Service. In the UK, if the incremental cost per QALY (= cost for one additional year in perfect health) is below GBP30,000, the treatment is usually made available. Many European countries are currently considering replicating the NICE model.
The QALY method is based on four key assumptions about how patients rate additional life and different health states. ECHOUTCOME, a three year, EUR1m project, brought together six universities and companies to investigate these assumptions, finding them all to be invalid. The research surveyed 1,300 respondents in Belgium, France, Italy and the UK, and is the largest investigation into QALYs ever undertaken.
The responses showed that the way people rate different medical outcomes cannot be summed up by a neat formula. The project concludes that QALY is an invalid way to make medical decisions and should be replaced by a more flexible approach. Gerard Duru, Emeritus Research Director in Mathematics at the French National Centre of Scientific Research said: "The underlying assumptions of QALY are not verified in a real population. The QALY indicator is not a valid scientific scale. It is impossible to know what we are measuring".
Ariel Beresniak, CEO of Data Mining International and Project Leader said: "Agencies such as NICE should abandon QALY in favour of other approaches. European HTA agencies currently looking to adopt the NICE model must seriously reconsider".
