The application of the QALY measure in the assessment of the effects of health interventions on an older population: a systematic scoping review

Abstract Background One of the most commonly used types of evaluation methods is cost-utility analysis (CUA), using the Quality Adjusted Life Year (QALY) indicator as a preference-based measure for assessing effects of a given programme. Such assessments are often translated into health-care provisi...

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Autores principales:	Ewa Kocot, Paulina Kotarba, Katarzyna Dubas-Jakóbczyk
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Quality adjusted life year (QALY) Older population Resource allocation Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/7e6ddc6891e948bfb603c99938224b12
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spelling	oai:doaj.org-article:7e6ddc6891e948bfb603c99938224b122021-11-21T12:12:07ZThe application of the QALY measure in the assessment of the effects of health interventions on an older population: a systematic scoping review10.1186/s13690-021-00729-72049-3258https://doaj.org/article/7e6ddc6891e948bfb603c99938224b122021-11-01T00:00:00Zhttps://doi.org/10.1186/s13690-021-00729-7https://doaj.org/toc/2049-3258Abstract Background One of the most commonly used types of evaluation methods is cost-utility analysis (CUA), using the Quality Adjusted Life Year (QALY) indicator as a preference-based measure for assessing effects of a given programme. Such assessments are often translated into health-care provision priorities; therefore, effectively choosing the method of outcome evaluation is crucial for ensuring the best possible allocation of scarce resources. The main objective of this scoping review is to identify what kinds of problems and limitations may occur when the QALY indicator is used to assess the effects of health interventions in the older population. Methods To identify literature in a scoping review, the databases MEDLINE via PubMed and Scopus were searched. A manual search on relevant organizations’ and associations’ websites was also conducted (EUnetHTA, ISPOR and national governmental agencies responsible for allocation decisions). No limits concerning publication dates were set. All relevant data were extracted and analyzed, then a narrative summary was prepared. Results The database search identified 10,832 relevant items, finally 32 studies were included in the analysis. The main types of issues indicated in the studies were as follows: (1) lower life expectancy in the older population causes lower QALY gains; (2) an equal value of one QALY is used regardless of age; (3) poorer average health state causes lower QALY gains; (4) inadequate instruments to measure quality of life (QoL); (5) attributes of QoL used regardless of age; and (6) no beyond-health QoL aspects taken into account. Conclusions This review shows clearly that many problems of different types are connected with using QALY for the older population, but there is no consensus as to whether QALY discriminates against the older population or not – an opinion regarding this issue depends strongly on accepted principles, particularly the approach to equity and how one understands fairness. Health care resources should not be allocated solely on the basis of the health maximization rule because this can lead to discrimination against certain groups (e.g., older, disabled, and/or chronically ill people). To maintain the balance between efficiency and equity, the issues connected with age-based rationing should be widely discussed.Ewa KocotPaulina KotarbaKatarzyna Dubas-JakóbczykBMCarticleQuality adjusted life year (QALY)Older populationResource allocationPublic aspects of medicineRA1-1270ENArchives of Public Health, Vol 79, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Quality adjusted life year (QALY) Older population Resource allocation Public aspects of medicine RA1-1270
spellingShingle	Quality adjusted life year (QALY) Older population Resource allocation Public aspects of medicine RA1-1270 Ewa Kocot Paulina Kotarba Katarzyna Dubas-Jakóbczyk The application of the QALY measure in the assessment of the effects of health interventions on an older population: a systematic scoping review
description	Abstract Background One of the most commonly used types of evaluation methods is cost-utility analysis (CUA), using the Quality Adjusted Life Year (QALY) indicator as a preference-based measure for assessing effects of a given programme. Such assessments are often translated into health-care provision priorities; therefore, effectively choosing the method of outcome evaluation is crucial for ensuring the best possible allocation of scarce resources. The main objective of this scoping review is to identify what kinds of problems and limitations may occur when the QALY indicator is used to assess the effects of health interventions in the older population. Methods To identify literature in a scoping review, the databases MEDLINE via PubMed and Scopus were searched. A manual search on relevant organizations’ and associations’ websites was also conducted (EUnetHTA, ISPOR and national governmental agencies responsible for allocation decisions). No limits concerning publication dates were set. All relevant data were extracted and analyzed, then a narrative summary was prepared. Results The database search identified 10,832 relevant items, finally 32 studies were included in the analysis. The main types of issues indicated in the studies were as follows: (1) lower life expectancy in the older population causes lower QALY gains; (2) an equal value of one QALY is used regardless of age; (3) poorer average health state causes lower QALY gains; (4) inadequate instruments to measure quality of life (QoL); (5) attributes of QoL used regardless of age; and (6) no beyond-health QoL aspects taken into account. Conclusions This review shows clearly that many problems of different types are connected with using QALY for the older population, but there is no consensus as to whether QALY discriminates against the older population or not – an opinion regarding this issue depends strongly on accepted principles, particularly the approach to equity and how one understands fairness. Health care resources should not be allocated solely on the basis of the health maximization rule because this can lead to discrimination against certain groups (e.g., older, disabled, and/or chronically ill people). To maintain the balance between efficiency and equity, the issues connected with age-based rationing should be widely discussed.
format	article
author	Ewa Kocot Paulina Kotarba Katarzyna Dubas-Jakóbczyk
author_facet	Ewa Kocot Paulina Kotarba Katarzyna Dubas-Jakóbczyk
author_sort	Ewa Kocot
title	The application of the QALY measure in the assessment of the effects of health interventions on an older population: a systematic scoping review
title_short	The application of the QALY measure in the assessment of the effects of health interventions on an older population: a systematic scoping review
title_full	The application of the QALY measure in the assessment of the effects of health interventions on an older population: a systematic scoping review
title_fullStr	The application of the QALY measure in the assessment of the effects of health interventions on an older population: a systematic scoping review
title_full_unstemmed	The application of the QALY measure in the assessment of the effects of health interventions on an older population: a systematic scoping review
title_sort	application of the qaly measure in the assessment of the effects of health interventions on an older population: a systematic scoping review
publisher	BMC
publishDate	2021
url	https://doaj.org/article/7e6ddc6891e948bfb603c99938224b12
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The application of the QALY measure in the assessment of the effects of health interventions on an older population: a systematic scoping review

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