One concern when utilizing high quality adjusted life years (QALY) to measure well being features for value effectiveness analysis is that QALYs “undervalue” well being features from life extension for individuals with severe sickness or power incapacity. To see this clearly, check out the QALY system (first system beneath) and the way it may be decomposed into modifications in high quality of life (Q) and survival (S) for a brand new intervention (listed at 1) in comparison with the previous (listed to 0).
Word that the survival features are solely valued on the high quality of life that the intervention can acheive (Q1t). Thus, survival enhancements for sufferers who stay having a poor high quality of life are devalued relative to those that woudl be in good and even excellent well being.
A paper by Campbell, Whittington and Pearson (2023) describes how the Institute for Scientific and Financial Assessment (ICER) computes an alternate measure: equal worth of life years gained (evLYG). I’ve described this method beforehand right here. evLYG may be calculated as follows:
On the correct hand aspect , the second time period is an identical in each the evLYG and QALY equations, indicating that high quality of life features throughout the survival interval of the primary particular person are evaluated the identical. Nonetheless, below evLYG, survival features are valued at another quantity (Qt) which may be totally different from the standard of life worth of the brand new remedy. Beneath the unique evLYG method proposed by Nord et al. (1999), survival features are valued at excellent well being (i.e., Qt=1). Nonetheless, the Campbell et al. method utilized by ICER, units Qt=0.851, which is the same as the common utility of the overall US grownup inhabitants. Word that the ICER method assigns decrease evLYG than does the Nord method.
Beneath ICER’s implementation of evLYG, the totally different in the best way well being features are measured between evLYG and QALYs may be summarized as follows:
evLYG have the important thing benefit that survival features to sicker sufferers are valued extra (though much less below ICER’s implementation than below Nord).
In reality, ICER’s evaluation of 32 distinctive interventions utilizing each evLYG and QALY discovered that in 66% of circumstances ΔevLYG>ΔQALY, and in 34% of circumstances ΔevLYG=ΔQALY. The imply proportion change between an intervention dyad’s incremental QALYs and incremental evLYs was 16%. Within the interventions the place ΔevLY > ΔQALY, incremental evLYs have been 25% greater than incremental QALYs.
One key limitation of evLYG is that high quality of life enhancements throughout the ‘survival achieve’ interval usually are not captured below evLYG.
You’ll be able to learn the total paper right here. It’s a helpful primer each on what evLYG is and the way ICER has been utilizing evLYG in its assessments.
