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Using QALYs versus DALYs to measure cost-effectiveness: How much does it matter?

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  • 1Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.

International Journal of Technology Assessment in Health Care
|April 29, 2020
PubMed
Summary

Quality-adjusted life-years (QALYs) and disability-adjusted life-years (DALYs) can differ in cost-effectiveness analysis (CEA), but these differences are usually small. Using either QALY- or DALY-based ratios rarely changes the overall conclusion about an intervention's value.

Keywords:
Cost-effectiveness analysisDALYMedical-decisionQALY

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Area of Science:

  • Health Economics
  • Pharmacoeconomics
  • Public Health

Background:

  • Quality-adjusted life-years (QALYs) and disability-adjusted life-years (DALYs) are standard metrics in cost-effectiveness analysis (CEA).
  • Understanding the differences between QALY- and DALY-based ratios is crucial for accurate health intervention assessment.

Purpose of the Study:

  • To quantify and explain discrepancies between QALY- and DALY-based cost-effectiveness ratios.
  • To determine if the choice of QALYs or DALYs significantly impacts conclusions on intervention cost-effectiveness.

Main Methods:

  • Systematic review of published CEAs using both QALYs and DALYs from the Tufts Medical Center CEA Registry and Global Health CEA Registry.
  • Calculation of absolute and relative differences between QALY- and DALY-based ratios, compared against standard benchmarks.
  • Conversion of all costs to US dollars for consistent comparison.

Main Results:

  • Eleven studies reported both QALYs and DALYs; most focused on pharmaceuticals/infectious disease in high-income countries.
  • Absolute differences in ratios ranged from $2 to $15,000 per unit of benefit, with relative differences from 6-120%.
  • Utility and disability weights were the primary drivers of observed differences; conclusions remained consistent across ratio types in 10 of 11 cases when compared to cost-effectiveness thresholds.

Conclusions:

  • QALY- and DALY-based ratios can vary for the same intervention.
  • Observed differences between QALY- and DALY-based ratios are generally modest.
  • The choice between QALYs and DALYs typically does not alter the cost-effectiveness conclusions when compared to established thresholds.