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Review and guidance for presenting cost-utility analysis with small QALY gains
Xuanqian Xie1, Olga Gajic-Veljanoski1, Myra Wang1
1Acute and Hospital-Based Care, Ontario Health, Toronto, ON, Canada.
Expert Review of Pharmacoeconomics & Outcomes Research
|August 7, 2026
Summary
Interpreting cost-utility analyses with small quality-adjusted life-year (QALY) gains requires careful consideration. This study offers guidance for presenting and understanding these results to improve health economic evaluations.
Area of Science:
- Health Economics
- Pharmacoeconomics
- Health Technology Assessment
Background:
- Quality-adjusted life-year (QALY) is key in health economic evaluations.
- Small QALY gains pose challenges for cost-effectiveness ratio stability.
- Uncertainty in small QALY denominators impacts analysis.
Purpose of the Study:
- To examine cost-utility analyses (CUAs) with small QALY gains (≤0.02).
- To develop preliminary guidance for presenting and interpreting CUAs with small QALY gains.
- To enhance standardization in health economic evaluation reporting.
Main Methods:
- Review of Health Technology Assessments (HTAs) from Ontario (2016-2026).
- Inclusion of CUAs reporting QALY gains ≤0.02 in main analyses.
- Analysis of 26 CUAs across 15 HTAs, focusing on testing and non-pharmaceutical treatments.
Main Results:
- Six HTAs evaluated testing technologies; nine evaluated non-pharmaceutical treatments.
- Key recommendations for interpreting small QALY gains include:
- Presenting QALY direction/magnitude, assessing consistency, justifying small gains, addressing cost uncertainty, enhancing probabilistic analysis, and estimating population-level gains for screening.
Conclusions:
- Preliminary guidance clarifies interpretation of CUAs with small QALY gains.
- The guidance promotes greater standardization in reporting health economic evaluations.
- Improved reporting enhances the understanding and application of economic evidence.
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