Bridging the Health Measurement Gap: Mission Impossible?

ISSUE: Bridging the Health Measurement Gap: Mission Impossible?

ISSUE DESCRIPTION:

Different agencies and researchers worldwide use different methods of measuring health, thus making comparisons across studies difficult. E.g., WHO uses DALYs, Statistical Agencies use life expectancy sometimes supplemented with disability data and/or QALY data, Technology assessors and economic evaluators often use QALYs but not always, clinical researchers use a variety of disease-specific measures and only occasionally use a general measure like QALYs.
Even those studies that all use QALYs are not comparable because they typically use different sources for the quality weights, and these different sources can give significantly different results.
There is value in a common acceptable standard approach for measuring and reporting the health of populations and groups that could be used worldwide in all studies as a “reference case”, thus enhancing comparability across studies. Although each study would be requested to use the “reference case” method, they could use other methods as well. ISPOR could take the lead in working towards the definition and acceptance of the reference case method. This proposal sets out the issue and the pros and cons of ISPOR's involvement and lead.

ANALYSIS:

Is lack of comparability across studies a problem? If not, there is no issue. If so, should ISPOR get involved?
The “reference case” approach was successfully used by the Panel on Cost-Effectiveness in Health and Medicine to define a set of standard methods to be used in all CEA studies. The objective was to provide comparability across studies.
The requirement to include the “reference case” method does not preclude the use of other methods as well. The “reference case” method simply provides the means to link and compare across studies.
How broadly should the issue be defined?
- Narrow: The issue would be restricted to summary measures of health, i.e., measures that integrate morbidity and mortality into a single summary metric (e.g., quality-adjusted life years, quality-adjusted life expectancy, etc.)
- Intermediate: The issue would be broadened to include the debate of QALYs vs WTP and possibly other alternatives as well?
- Broad: The issue could be broadened even more to include the whole area of health-related quality of life and patient-reported outcomes.
- We recommend the narrow definition, at least for starters. Even it is contentious enough. I.e., the reference case would only be for those studies that wish to measure health on a 0-1 scale integrating quality and quantity of life.

In the UK, NICE has specified in their “reference case” that QALYs should be used and that the weights should be relevant to the NHS population.
If ISPOR takes this on, it should be seen as a long-range objective that may take a number of years to achieve. This is not something that can be done easily or overnight. Moreover, even if a “reference case” is developed and adopted, it will have to be maintained and updated over time. Thus, taking this on implies an ongoing commitment or at least the need to establish some kind of ongoing process.

RECOMMENDED ACTION FOR ISPOR

Organize a special workshop on the topic bringing together representatives of the various stakeholders. The workshop could be passive (all parties present their views) or active (attempt to achieve a consensus on a reference case). Publish the results. Hopefully the discussion will lead to some positive direction forward and will not be simply a review (there are enough reviews already).
Organize a session on this topic at the ISPOR Annual Meetings.