The QALY: a guide for the public health physician

This paper considers the background to the rational allocation of health resources at DHA level within the context of the new purchaser/provider regime. A popular approach to this problem has been that of cost utility analysis, using quality adjusted life years (QALYs) as the measure of the benefit derived from a health intervention. This paper seeks to offer the practising public health physician an appraisal of the practical value and pitfalls of a QALY-based approach. To this end, the theoretical background to QALYs and their practical use are described and some of the practical and ethical problems and pitfalls are discussed. It is concluded that the QALY concept provides a useful tool in aiding decision making in the allocation of health care resources, but that it is too early for a universal application of the approach.