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Health and Quality of Life Outcomes BioMed Central Commentary Open Access Problems and solutions

Health and Quality of Life Outcomes BioMed Central Commentary Open Access Problems and solutions in calculating quality-adjusted life years (QALYs) Luis Prieto* and José A Sacristán Address: Health Outcomes Research Unit. Eli Lilly & Co. Spain. Av. de la Industria 30, 28108 Alcobendas, Spain Email: Luis Prieto* - prieto_luis@lilly.com; José A Sacristán - sacristan_jose@lilly.com * Corresponding author Published: 19 December 2003 Health and Quality of Life Outcomes 2003, 1:80 This article is available from: http://www.hqlo.com/content/1/1/80 Received: 22 October 2003 Accepted: 19 December 2003 © 2003 Prieto and Sacristán; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all. | BioMed Central Health and Quality of Life Outcomes Commentary Problems and solutions in calculating quality-adjusted life years QALYs Luis Prieto and José A Sacristán Open Access Address Health Outcomes Research Unit. Eli Lilly Co. Spain. Av. de la Industria 30 28108 Alcobendas Spain Email Luis Prieto - prieto_luis@lilly.com José A Sacristán - sacristan_jose@lilly.com Corresponding author Published 19 December 2003 Received 22 October 2003 Accepted 19 December 2003 Health and Quality of Life Outcomes 2003 1 80 r This article is available from http www.hqlo.com content l l 80 2003 Prieto and Sacristán licensee BioMed Central Ltd. This is an Open Access article verbatim copying and redistribution of this article are permitted in all media for any purpose provided this notice is preserved along with the article s original URL. Abstract The quality-adjusted life-year QALY is a measure of the value of health outcomes. Since health is a function of length of life and quality of life the QALY was developed as an attempt to combine the value of these attributes into a single index number. The QALY calculation is simple the change in utility value induced by the treatment is multiplied by the duration of the treatment effect to provide the number of QALYs gained. QALYs can then be incorporated with medical costs to arrive at a final common denominator of cost QALY. This parameter can be used to compare the cost-effectiveness of any treatment. Nevertheless QALYs have been criticised on technical and ethical grounds. A salient problem relies on the numerical nature of its constituent parts. The appropriateness of the QALY arithmetical operation is compromised by the essence of the utility scale while life-years are expressed in a ratio scale with a true zero the utility is an interval scale where 0 is an arbitrary value for death. In order to be able to obtain coherent results both scales would have to be expressed in the same units of measurement. The different nature of .