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The Future of Quality of Life Assessment in Cost-Effectiveness Research

Explore the evolution of Quality-Adjusted Life Years (QALYs) in healthcare decision-making from 1980 to present, the controversy surrounding them, and the potential for new methodologies to enhance quality of life assessment in cost-effectiveness research. This analysis delves into the role of severity, innovation, and disease-specific instruments, providing insights into the value judgments and measures that shape healthcare policies. Discover the current landscape, future possibilities, and questions surrounding health state valuation methodologies.

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The Future of Quality of Life Assessment in Cost-Effectiveness Research

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  1. The Future of Quality of Life Assessment in Cost-Effectiveness Research Prof. Jan J. v. Busschbach, Ph.D. Erasmus MC Medical Psychology and Psychotherapy Viersprong Institute for studies on Personality Disorders

  2. QoL in HTA: QALY

  3. In the past, much criticism Cohen CB. Quality of life and the analogy with the Nazis. Journal of Medicine and Philosophy 8: 113-35, 1983.

  4. Criticism remains ….the strictly fascist essence of those QALYs (so-called Quality-Adjusted Life Years)…

  5. But QALY rules… From 1980 till 2010: 7049 publications in PubMed

  6. There is not yet an alternative…

  7. Raad voor de Volksgezondheid en Zorg • Weight QALYs by severity of illness • QALYs determine “severity”

  8. Value based pricing • Health Secretary Andrew Lansley • Measures "will help ensure better access for patients to effective drugs and innovative treatments on the NHS" • Like RvZ • Again adding severity • Adding Innovation • QALY still at the hart of the judgment • Severity and innovation both expressedterms of QALYs

  9. Efficiency frontier • Germany • IQWiG • Still discussion • whether it is possible ‘in theory’ to make such value judgments, let alone in practice

  10. Which measure? • Questionnaires • EQ-5D • HUI • SF-6D • Direct measures • TTO • Discrete choice • SG • VAS

  11. Questionnaires • EQ-5D • Dominates health economics • Said to be insensitive • New 5 level version is on its way • SF-6D • Overtook HUI in popularity • Little support development • HUI • Little recent development • Expensive

  12. Disease specific instruments • As validation methodology becomes cheaper… • Why not validate a disease specific instrument? • The big research question • Are values valid? • Are the values the same as with HUI, SF-6D etc • Narrow scope • Values are too high • Attention bias • Differences are too big

  13. Bold-on instruments • Combine generic instruments with disease specific dimensions • “Bold-on” the disease specific dimension • Can solve the narrow scope • Absolute value level might be valid • Could avoid attention bias • Does it also avoid the attention bias?

  14. Direct measures • Used to value health states in models • TTO dominates • Discrete choice coming up • SG slips aside • VAS not in favor in health economics • WTP never more than a promise

  15. The big questions • TTO • Values below dead • Discrete choice • Is discrete choice valid within the QALY approach? • How to anchor in death – normal health scale • TTO?

  16. Care • QALY in care is disputed • But QALY is ok for big issues in care • No care = dead • QALY might not be sensitive • Care might be involve other aspects than health • For instance: does not measure autonomy • Same issues as in cure? • Disease specific instrument • Involve need and innovation

  17. Discrete choice in care • New instrument for care • ICECAP • ASCOTT • Several other initiatives • What is the relation with QALY? • Why go for another scale?

  18. Conclusion: Standardization • Questionnaires • Could merge to EQ-5D • But disease specific instruments might blur • Direct valuation • TTO seems to prevail, but not yet one methodology • Care • Just the start of development

  19. Future questionnaires • Cheap EQ-5D SF-6D HUI • Sensitive SF-6D HUI EQ-5D (3L) • Simple to use EQ-5D SF-6D HUI • Many translations SF-6D EQ-5D HUI • Many value sets EQ-5D HUI SF-6D • Will EQ-5D-5L dominate? • There must be room for more instruments…

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