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Quantifying life: Understanding the history of Quality-Adjusted Life-Years (QALYs)

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  • MacKillop, Eleanor
  • Sheard, Sally

Abstract

Quality-Adjusted Life-Years (QALYs) are central to healthcare decision-making in Britain and abroad, yet their history is poorly understood. In this paper, we argue that a more in-depth and political history of the QALY is needed to allow a critical evaluation of its current dominance. Exploiting rich data from archives and 44 semi-structured interviews conducted between 2015 and 2018, we employ Multiple Streams Analysis to construct a complex and dynamic picture of how the idea of QALYs emerged and was adopted within UK health policy. Through its historical and political approach, the paper illuminates the relative roles in the policy-making process of experts (especially economists) and politicians as ‘entrepreneurs’ in the development of new ideas; how these were influenced by negotiation within established and emerging institutional structures; and the role of serendipity and crisis.

Suggested Citation

  • MacKillop, Eleanor & Sheard, Sally, 2018. "Quantifying life: Understanding the history of Quality-Adjusted Life-Years (QALYs)," Social Science & Medicine, Elsevier, vol. 211(C), pages 359-366.
    • Handle: RePEc:eee:socmed:v:211:y:2018:i:c:p:359-366
    DOI: 10.1016/j.socscimed.2018.07.004
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    References listed on IDEAS

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    Cited by:

    1. Spencer, Anne & Rivero-Arias, Oliver & Wong, Ruth & Tsuchiya, Aki & Bleichrodt, Han & Edwards, Rhiannon Tudor & Norman, Richard & Lloyd, Andrew & Clarke, Philip, 2022. "The QALY at 50: One story many voices," Social Science & Medicine, Elsevier, vol. 296(C).
    2. Nathan S. McClure & Mike Paulden & Arto Ohinmaa & Jeffrey A. Johnson, 2021. "Modifying the quality-adjusted life year calculation to account for meaningful change in health-related quality of life: insights from a pragmatic clinical trial," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(9), pages 1441-1451, December.
    3. Paul Mark Mitchell & Samantha Husbands & Sarah Byford & Philip Kinghorn & Cara Bailey & Tim J. Peters & Joanna Coast, 2021. "Challenges in developing capability measures for children and young people for use in the economic evaluation of health and care interventions," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 1990-2003, September.
    4. Johanna Vásquez & Sergio Botero, 2020. "Hybrid Methodology to Improve Health Status Utility Values Derivation Using EQ-5D-5L and Advanced Multi-Criteria Techniques," IJERPH, MDPI, vol. 17(4), pages 1-18, February.

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