Are methods for estimating QALYs in cost-effectiveness analyses improving?

Med Decis Making. Oct-Dec 1997;17(4):402-8. doi: 10.1177/0272989X9701700405.


Objectives: The objectives of this study were to examine variations in the methods used by researchers to estimate QALYs in published cost-effectiveness analyses, and to investigate whether the methods have improved over time.

Data and methods: Using a MEDLINE search, the authors identified 86 original cost-effectiveness analyses, published between 1975 and 1995, that used QALYs as the measure of effectiveness. For each study, they recorded the health-state classification system, the source of the preference weights, the measurement technique, and the discount rate. The methods used were compared with the recommendations of the U.S. Panel on Cost-Effectiveness in Health and Medicine.

Results: Only 20% of the studies used "generic" health-state classification systems (e.g., health utilities index); 21% relied on community-based weights; 40% used formal measurement techniques (e.g., time-tradeoff method); and 88% discounted both future costs and QALYs. There was little evidence that methods had improved over time.

Conclusions: The results illustrate extensive variation in the construction of QALYs in cost-effectiveness analyses and reveal that most studies have not adhered to practices now recommended by leaders in the field. There is a need for more methodologic rigor and consistency if the results of such studies are to be compared and used for purposes of allocating resources.

Publication types

  • Review

MeSH terms

  • Classification
  • Cost-Benefit Analysis
  • Decision Support Techniques*
  • Health Care Costs*
  • Humans
  • Quality-Adjusted Life Years*
  • Research Design