QALYs and the equity-efficiency trade-off

As the volume of research on quality-adjusted life years (QALYs) has increased, concern has begun to be expressed about the equity aspects of resource allocation decisions based on the results of this research. This paper suggests that a common theme running through the criticisms of the QALY approach is a concern about inequality. It also suggests that the method for incorporating distributional concerns which is currently being pursued by advocates of the QALY approach will only ever capture concerns other than a concern about inequality. The paper suggests a method for incorporating both sets of concerns into resource allocation decisions.