Is the QALY blind, deaf and dumb to equity? NICE's considerations over equity

Br Med Bull. 2012;101:17-31. doi: 10.1093/bmb/lds003. Epub 2012 Feb 13.


Introduction/background: The quality-adjusted life year (QALY) is the preferred measure of health outcome used to inform decisions over the use of health care interventions in the UK NHS. This measure considers the overall impact of alternative interventions on both the quantity and quality of life.

Sources of data: Review of the relevant literature. Areas of agreement The QALY assumes that health improvement is equally valued between individuals. Areas of controversy Some can perceive as equitable, that is fair, the assumption that health improvement is equally valued between individuals in the QALY. However, others may believe that this assumption leaves no space for alternative views over equity to be explicitly considered in societal decision making.

Growing points: The role of equity in decision making in the UK has been subject of intense debate, and controversy, and to-date there is no consensus on whether, or how, should NICE should change their general process.

Areas timely for developing research: Further examination of the issues needs to be debated and researched.

Publication types

  • Review

MeSH terms

  • Decision Making
  • Government Agencies
  • Health Care Rationing / methods*
  • Health Status Disparities
  • Humans
  • Quality-Adjusted Life Years*
  • State Medicine / organization & administration
  • United Kingdom