ISSUE: Decision-makers often use the mantra ‘a QALY is a QALY’: a unit of health gain has the same value, regardless of who benefits. But is that mantra appropriate, and is it followed? Recent research suggests that child health state values tend to exceed values for corresponding adult health states. This has implications for the evaluation of technologies that cover both children and adults, and for clinical trials in which participants are children at baseline and transition to adulthood by the end of the trial/model. It also raises questions about social value. Does society consider child QALYs and adult QALYs to be equivalent? If not, is it appropriate to reflect age-related preferences in value sets or to introduce QALY weights/modifiers? What should these weights be based on?

OVERVIEW: Moderator Koonal Shah will open the session by summarizing the issues. Richard Norman will explain how the issues are being tackled in Australia, where he is leading research on the comparability of child and adult QALYs with decision-makers, patient representatives and the public. Rosie Lovett will provide the perspective of an HTA agency, describing NICE’s current decision-making approach and the research that has informed NICE’s policy. She will explore how to interpret child QALYs and use them in decision-making. Vivian Reckers-Droog will present research on age-related preferences from the Netherlands, noting how current decision-making frameworks fail to reflect these preferences. She will argue that preferences for setting priorities based on age should be disentangled from preferences that feed into QALY estimates. Following the three 10-minute presentations, the remainder of the session will be reserved for panel/audience discussion, with suggestions on how to link research with the needs of policy-makers particularly welcomed. Polling questions will be administered to seek the audience’s views on key (and in some cases controversial) questions raised by the panelists.