BEYOND THE SINGLE QALY: CHALLENGES IN APPLYING NON-HALY OUTCOMES IN ECONOMIC EVALUATIONS
Author(s)
Yilin Deng, Master's degree1, Yu Xin, Master's degree2, Yuanyi Cai, Doctorate3, Changjin Wu, Doctorate4, Jun Hao, Doctorate5, Xiaohui Ren, Doctorate1, Wen Hui, Doctorate2;
1Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China, Chengdu, China, 2Department of Science and Technology, West China Hospital of Sichuan University, Chengdu, China, Chengdu, China, 3Department of Health Service Management, School of Health Management, China Medical University, Shenyang, China, Shenyang, China, 4College of Public Health, Chongqing Medical University, Chongqing, China, Chongqing, China, 5Clinical Trial Research Center, The First Affiliated Hospital of Nanchang University，Nanchang, 330006, China, Nanchang, China
1Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China, Chengdu, China, 2Department of Science and Technology, West China Hospital of Sichuan University, Chengdu, China, Chengdu, China, 3Department of Health Service Management, School of Health Management, China Medical University, Shenyang, China, Shenyang, China, 4College of Public Health, Chongqing Medical University, Chongqing, China, Chongqing, China, 5Clinical Trial Research Center, The First Affiliated Hospital of Nanchang University，Nanchang, 330006, China, Nanchang, China
OBJECTIVES: Health-adjusted life years (HALYs), such as QALYs and DALYs, face increasing criticism for their limitations in capturing diverse health outcomes. This cross-sectional survey comprehensively investigated the adoption of non-HALYs indicators in recent economic evaluations and identified key methodological challenges.
METHODS: We searched PubMed for full economic evaluations published between January 1, 2023, and March 18, 2025, in journals ranked within the top 5% by Journal Impact Factor across 51 Clinical Medicine subcategories according to the Journal Citation Reports. Two independent reviewers extracted data on study design, perspective, research domain, outcome type, cost-effectiveness thresholds (CETs), and corresponding conclusions.
RESULTS: Among the 363 included studies, only 17.63% (64/363) used non-HALYs measures, involving 118 outcome measures (36 HALYs, 82 non-HALYs). While 97.22% (35/36) of HALYs measures reported a predefined CET, only 26.83% (22/82) of non-HALYs measures did so. When a CET was specified, HALYs measures predominantly referenced published literature (53.33%), whereas non-HALYs measures were most frequently cited WHO recommendation for DALYs (41.18%). Among studies using multiple outcome measures (n=43), 30.23% (13/43) presented incremental cost-effectiveness ratios (ICERs) located entirely in the northwest (more costly, less effective) and southeast (less costly, more effective) quadrants of the cost-effectiveness plane, allowing conclusions to be drawn without CETs. In contrast, more than half of studies (22/43) with ICERs in the northeast (more costly, more effective) or southeast (less costly, less effective) quadrant relied on CETs to reach definitive conclusions. Nevertheless, 90.70% (39/43) of multi-outcome studies reported definitive economic conclusions, even in the absence of consistently applied thresholds across conflicting quadrants.
CONCLUSIONS: Non-HALYs outcomes remain underutilized and inconsistently reported in current economic evaluations. Key methodological gaps include insufficient CET specification and transparency for non-HALYs measures, as well as a lack of standardized approaches for interpreting multiple outcomes, particularly when they indicate conflicting cost-effectiveness directions.
METHODS: We searched PubMed for full economic evaluations published between January 1, 2023, and March 18, 2025, in journals ranked within the top 5% by Journal Impact Factor across 51 Clinical Medicine subcategories according to the Journal Citation Reports. Two independent reviewers extracted data on study design, perspective, research domain, outcome type, cost-effectiveness thresholds (CETs), and corresponding conclusions.
RESULTS: Among the 363 included studies, only 17.63% (64/363) used non-HALYs measures, involving 118 outcome measures (36 HALYs, 82 non-HALYs). While 97.22% (35/36) of HALYs measures reported a predefined CET, only 26.83% (22/82) of non-HALYs measures did so. When a CET was specified, HALYs measures predominantly referenced published literature (53.33%), whereas non-HALYs measures were most frequently cited WHO recommendation for DALYs (41.18%). Among studies using multiple outcome measures (n=43), 30.23% (13/43) presented incremental cost-effectiveness ratios (ICERs) located entirely in the northwest (more costly, less effective) and southeast (less costly, more effective) quadrants of the cost-effectiveness plane, allowing conclusions to be drawn without CETs. In contrast, more than half of studies (22/43) with ICERs in the northeast (more costly, more effective) or southeast (less costly, less effective) quadrant relied on CETs to reach definitive conclusions. Nevertheless, 90.70% (39/43) of multi-outcome studies reported definitive economic conclusions, even in the absence of consistently applied thresholds across conflicting quadrants.
CONCLUSIONS: Non-HALYs outcomes remain underutilized and inconsistently reported in current economic evaluations. Key methodological gaps include insufficient CET specification and transparency for non-HALYs measures, as well as a lack of standardized approaches for interpreting multiple outcomes, particularly when they indicate conflicting cost-effectiveness directions.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
MSR46
Topic
Methodological & Statistical Research
Disease
No Additional Disease & Conditions/Specialized Treatment Areas