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Open Access Highly Accessed Debate

The social value of a QALY: raising the bar or barring the raise?

Cam Donaldson12*, Rachel Baker12, Helen Mason2, Michael Jones-Lee3, Emily Lancsar23, John Wildman23, Ian Bateman4, Graham Loomes5, Angela Robinson6, Robert Sugden7, Jose Luis Pinto Prades8, Mandy Ryan9, Phil Shackley10 and Richard Smith11

Author affiliations

1 Yunus Centre for Social Business & Health, Research Institutes, 3rd Floor Buchanan House, Glasgow Caledonian University, Cowcaddens Road Glasgow, G4 0BA, UK

2 Institute of Health & Society, Newcastle University, UK

3 Newcastle University Business School, UK

4 Centre for Social and Economic Research on the Global Environment, University of East Anglia, UK

5 Department of Economics, University of Warwick, UK

6 Angela Robinson, Health, Policy and Practice, University of East Anglia, UK

7 School of Economic and Social Studies, University of East Anglia, UK

8 Department of Economics, University Pablo de Olavide, Sevilla, Spain

9 Health Economics Research Unit, University of Aberdeen, UK

10 Phil Shackley, Sheffield Vascular Institute, University of Sheffield, UK

11 Richard Smith, London School of Hygiene and Tropical Medicine, UK

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Citation and License

BMC Health Services Research 2011, 11:8  doi:10.1186/1472-6963-11-8

Published: 11 January 2011

Abstract

Background

Since the inception of the National Institute for Health and Clinical Excellence (NICE) in England, there have been questions about the empirical basis for the cost-per-QALY threshold used by NICE and whether QALYs gained by different beneficiaries of health care should be weighted equally. The Social Value of a QALY (SVQ) project, reported in this paper, was commissioned to address these two questions. The results of SVQ were released during a time of considerable debate about the NICE threshold, and authors with differing perspectives have drawn on the SVQ results to support their cases. As these discussions continue, and given the selective use of results by those involved, it is important, therefore, not only to present a summary overview of SVQ, but also for those who conducted the research to contribute to the debate as to its implications for NICE.

Discussion

The issue of the threshold was addressed in two ways: first, by combining, via a set of models, the current UK Value of a Prevented Fatality (used in transport policy) with data on fatality age, life expectancy and age-related quality of life; and, second, via a survey designed to test the feasibility of combining respondents' answers to willingness to pay and health state utility questions to arrive at values of a QALY. Modelling resulted in values of £10,000-£70,000 per QALY. Via survey research, most methods of aggregating the data resulted in values of a QALY of £18,000-£40,000, although others resulted in implausibly high values. An additional survey, addressing the issue of weighting QALYs, used two methods, one indicating that QALYs should not be weighted and the other that greater weight could be given to QALYs gained by some groups.

Summary

Although we conducted only a feasibility study and a modelling exercise, neither present compelling evidence for moving the NICE threshold up or down. Some preliminary evidence would indicate it could be moved up for some types of QALY and down for others. While many members of the public appear to be open to the possibility of using somewhat different QALY weights for different groups of beneficiaries, we do not yet have any secure evidence base for introducing such a system.