Estimating QUALY gains in applied studies: A review of cost-utility analyses published in 2010
Journal article, Peer reviewed
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http://hdl.handle.net/11250/2366843Utgivelsesdato
2014Metadata
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Sammendrag
Reimbursement agencies in several countries
now require health outcomes to be measured in terms of
quality-adjusted life-years (QALYs), leading to an immense
increase in publications reporting QALY gains. However,
there is a growing concern that the various ‘multi-attribute
utility’ (MAU) instruments designed to measure the Q in the
QALY yield disparate values, implying that results from
different instruments are incommensurable. By reviewing
cost-utility analyses published in 2010, we aim to contribute
to improved knowledge on how QALYs are currently calculated
in applied analyses; how transparently QALY measurement
is presented; and how large the expected
incremental QALY gains are. We searched Embase, MEDLINE
and NHS EED for all cost-utility analyses published in 2010. All analyses that had estimated QALYs gained from
health interventions were included. Of the 370 studies
included in this review, 48 % were pharmacoeconomic
evaluations. Active comparators were used in 71 % of studies.
The median incremental QALY gain was 0.06, which
translates to 3 weeks in best imaginable health. The EQ-5D-
3L is the dominant instrument used. However, reporting of
how QALY gains are estimated is generally inadequate. In
55 % of the studies there was no reference to which MAU
instrument or direct valuation method QALY data came
from. The methods used for estimating expectedQALYgains
are not transparently reported in published papers. Given the
wide variation in utility scores that different methodologies
may assign to an identical health state, it is important for
journal editors to require a more transparent way of reporting
the estimation of incremental QALY gains.