Using QALYs in Cancer: A Review of the Methdological Limitations

Objective: The objective of this paper is to examine how well the QALY captures the health gains generated by cancer treatments, with particular focus on the methods for constructing QALYs preferred by NICE. Methods: Data were obtained using a keyword search of the MEDLINE database and a hand search of articles written by leading researchers in the subject area (with follow-up of the references in these articles). Key arguments were discussed and developed at the Office of Health Economics oncology workshop in September 2009. Results: Three key issues emerge. First, the EQ-5D, NICE’s preferred measure of health-related quality of life in adults, has been found to be relatively insensitive to changes in health status of cancer patients. Second, the time trade-off, NICE’s preferred technique for estimating the values of health states, involves making assumptions that are likely to be violated in end-of-life scenarios. Third, the practice of using valuations of members of the general population, as recommended by NICE, is problematic because such individuals typically display a misunderstanding of what it is really like for patients to live with cancer. Conclusions: Because of the way in which it is constructed, the QALY shows important limitations in terms of its ability to accurately capture the value of the health gains deemed important by cancer patients. The paper concludes by proposing a research agenda for addressing these limitations.