JAMA   
May 4, 2011, Vol 305, No. 17, pp 1733-1824
http://jama.ama-assn.org/current.dtl

Commentaries
What Next for QALYs?
Peter J. Neumann
JAMA. 2011;305(17):1806-1807.doi:10.1001/jama.2011.566

Extract
The quality-adjusted life-year (QALY) has come under fire lately. In the United States, health reform legislation prohibited use of cost-per-QALY thresholds. 1 The United Kingdom has proposed that the National Institute for Health and Clinical Excellence (NICE), which has influenced reimbursement through cost-per-QALY ratios, will not in the future use such information to make yes or no recommendations; instead NICE’s cost-effectiveness assessments would provide an input into price negotiations for technologies. 2 In Germany, the Institute for Quality and Efficiency in Health Care implemented a new system for evaluating the value of medical technologies but rejected the cost-per-QALY model on ethical and methodological grounds. 3 Many countries (including France, Spain, and Italy) have opted for other approaches. Other articles have criticized use of QALYs. 4, 5

The drawbacks of QALYs are well known. QALYs represent health over time as a series of preference-weighted health states, for which the preference …