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Are methods for estimating QALYs in cost-effectiveness analyses improving?
P J Neumann1, D E Zinner, J C Wright
1Program on the Economic Evaluation of Medical Technology, Harvard School of Public Health, Boston, MA 02115, USA. pneumann@hsph.harvard.edu
Objectives:
The objectives of this study were to examine variations in the methods used by researchers to estimate QALYs in published cost-effectiveness analyses, and to investigate whether the methods have improved over time.
Data And Methods:
Using a MEDLINE search, the authors identified 86 original cost-effectiveness analyses, published between 1975 and 1995, that used QALYs as the measure of effectiveness. For each study, they recorded the health-state classification system, the source of the preference weights, the measurement technique, and the discount rate. The methods used were compared with the recommendations of the U.S. Panel on Cost-Effectiveness in Health and Medicine.
Results:
Only 20% of the studies used "generic" health-state classification systems (e.g., health utilities index); 21% relied on community-based weights; 40% used formal measurement techniques (e.g., time-tradeoff method); and 88% discounted both future costs and QALYs. There was little evidence that methods had improved over time.
Conclusions:
The results illustrate extensive variation in the construction of QALYs in cost-effectiveness analyses and reveal that most studies have not adhered to practices now recommended by leaders in the field. There is a need for more methodologic rigor and consistency if the results of such studies are to be compared and used for purposes of allocating resources.