Quantifying life: Understanding the history of Quality-Adjusted Life-Years (QALYs)

Abstract

Quality-Adjusted Life-Years (QALYs) are central to healthcare decision-making in Britain and abroad, yet their history is poorly understood. In this paper, we argue that a more in-depth and political history of the QALY is needed to allow a critical evaluation of its current dominance. Exploiting rich data from archives and 44 semi-structured interviews conducted between 2015 and 2018, we employ Multiple Streams Analysis to construct a complex and dynamic picture of how the idea of QALYs emerged and was adopted within UK health policy. Through its historical and political approach, the paper illuminates the relative roles in the policy-making process of experts (especially economists) and politicians as ‘entrepreneurs’ in the development of new ideas; how these were influenced by negotiation within established and emerging institutional structures; and the role of serendipity and crisis.

IMAGINE study protocol of a clinical trial: a multi-center, investigator-blinded, randomized, 36-month, parallel-group to compare the effectiveness of motivational interview in rehabilitation of older stroke survivors

“…QALYs will be derived using the EQoL-5D before and after the treatment and at 3 months. Therefore, cost-utility will be calculated as the incremental ratio in € for 1 QALYs in the intervention vs. control group [50,51].…”

Problematic cost–utility analysis of interventions for behavior problems in children and adolescents

“…The idea behind QALY was introduced in a paper by Klarman, Francis, and Rosenthal (1968) on the advantages of transplantation versus dialysis in patients with renal failure (see also MacKillop & Sheard, 2018). In this paper Klarman not only took into account the number of years of life added by each of the treatments, but also the quality of these extra years of life after transplantation, which was estimated to be 25% better than with dialysis.…”

Historicising “containment and delay”: COVID-19, the NHS and high-risk patients

“…For instance, programmes to care for the elderly and vulnerable have once again relied on the mobilisation of hundreds of thousands of volunteers (to undertake phone calls, food deliveries and other tasks), whilst the continued reliance on racialised labour in key worker roles – combined with the persistent effects of structural violence – have meant that BAME communities are dying disproportionately of COVID-19 . Moreover, though at the time of writing (May 2020) we have thankfully yet to see Government funding decisions forcing NHS staff to choose who might receive life-saving respiration and who misses out, the existence of standardised (yet culturally loaded) technologies for weighing the costs of different interventions against quality and quantity of life are of concern to those whose lives are often constructed as of “lesser” value (on the history of these technologies: Armstrong et al , 2007 ; MacKillop & Sheard, 2018 ). Indeed, concerns among disability rights groups, and other organisations and communities, have been (legitimately) heightened by ethical discussions regarding “brutal” decisions on treatment that might be required soon ( British Medical Association, 2020 ), and by suspicions that the biopolitical calculations of loss embedded in conceptions of “herd immunity” ( Hinchliffe, 2020 ) are still informing government and NICE policy (despite utterances to the contrary ).…”