QALYs for resource allocation: probably not and certainly not now

Quality-adjusted life years (QALYs) have the attractive characteristic of combining morbidity and mortality into a single index which purports to measure the outcomes of health interventions. Their primary aim, when combined with cost, is to permit comparisons across candidate spending programs and thereby promote economic efficiency in the use of rationed funds. QALYs, in fact, comprise a family of measures with major differences in approach and many variations in construction, process and methods of measurement. A necessary unifying characteristic is the ethical assumption of utilitarianism. The paper examines the state of the art in the development of QALY measures. It concludes that they fall far short of requirements for their advocated use in resource allocation decisions. Furthermore, their demands on measurement for this purpose are such that it is unlikely that methodological problems can be solved.