Quality of Life Adjustments Don’t Matter for Cancer Treatment Cost Effectiveness

In a paper in Expert Review of Pharmacoeconomics & Outcomes Research, Dan Greenberg from Ben-Gurion University of the Negev and Peter J. Neumann from the Center for the Evaluation of Value and Risk in Health conclude that when it comes to determining the cost effectiveness of cancer treatments, quality of life adjustments really don’t matter. Many countries, including the UK, Canada and Australia take cost-effectiveness into account when deciding whether to reimburse for a treatment. (In the US we’re doing our best to avoid that, but eventually the policy is likely to change.) Health economists like using quality-adjusted life years (QALYs) as outcome measures because they incorporate improvements in morbidity and mortality in a single measure. But methods for calculating QALYs are somewhat controversial, since accurate determination requires good measurements of patients’ health states, which is hard to accomplish. Different methods of obtaining this information have been shown to yield different results, so there is suspicion that the use of QALYs could result in inappropriate reimbursement decisions. The researchers analyzed 117 cancer-related studies that included both a cost per life-year (unadjusted for quality of life) and a QALY calculation. As it turns out these indicators are highly correlated. Reimbursement decisions for cancer treatment are really not impacted by how the QALY is calculated –or even whether it’s calculated at all. The authors speculate that using QALYs is likely to have the most impact in treatments for chronic conditions where there are sustained side effects from the treatments themselves.