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Are Methods for Estimating QALYs in Cost-Effectiveness Analyses Improving?

Darren E. Zinner, MS

Janice C. Wright, PhD

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, pub lished 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-Effective ness 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. Key words: QALYs; quality-adjusted; cost-effectiveness analysis. (Med Decis Making 1997;17: 402-408)

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