QALYs versus HYEs - What's Right and What's Wrong

The last two decades have seen cost-utility analysis of health care programmes becoming increasingly popular, both at the theoretical level and in empirical applications. This certainly explains why utility measurement in health care has attained such a prominent position in the field of health economics. On the benefit side of changes in resource allocation, the twin aspects of morbidity and mortality effects are to be combined to yield an assessment in line with individual preferences. Thus, at least in theory, the utility of the people involved provides the yardstick with which to gauge health effects. In order to obtain economically meaningful descriptions of the utility impact due to changes in individual health, two approaches currently coexist on somewhat less than peaceful terms. The older one, the quality-adjusted life years (henceforth: QALY) approach, lends itself to empirical application fairly easily since several methods have been devised in order to capture the QALY impact due to health care programmes. More recently, its position has been challenged by the healthy-years equivalent (henceforth: HYE) approach, mainly on the grounds that the QALY approach be likely to misrepresent individual preferences for health effects.