Presentation (CTI)

OBJECTIVES: Quality-adjusted life-years (QALYs) are the predominant measure of health benefit in international health technology assessment (HTA) processes. They have been described as discriminatory, hindering their use in the US. Life years (LYs), Equal-value life-years (evLYs) and Health years in total (HYT) have been proposed as alternatives. We created three economic models for oncology indications, and discuss the implications of using such measures for HTA in place of (or alongside) QALYs.
METHODS: Economic models were created for treatment of renal cell carcinoma, chronic myeloid leukemia, and lung cancer. We compared QALY outcomes to the models’ estimated LYs, evLYs, and HYT.
RESULTS: Incremental HYT consistently yielded the most favorable treatment benefit (13-46% higher). Absolute and incremental evLYs and QALYs were closely aligned except in lung cancer, which had higher incremental evLYs (22%) due to higher survival rates and a greater differential between health state utilities. The ratio of LYs to QALYs varied considerably (from 63% lower to 43% higher). Costs remain unchanged regardless of the health benefit measure used.
CONCLUSIONS: The models’ parameters varied in terms of utilities, overall survival, and progression-free survival rates; their respective impacts on HTA results are discussed. Based on these results, the use of evLYs (and likely HYT) are expected to have a minimal effect on HTA decision making in practice. Use of LYs could lead to more unpredictable results, while they furthermore ignore benefits to patient quality of life. QALYs are but one summary measure; these alternative measures could also be used alongside them, though it’s not immediately clear what they would add. The longstanding need for an approach (or set of approaches) that better incorporates tradeoffs between patient, provider and social perspectives remains.