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QALYs versus HYEs - a theoretical exposition


  • Tony J Culyer
  • Adam Wagstaff


There has been a vigorous dispute about quality adjusted life years (QALYs) and it has been argued that they are an inappropriate measure of patient utility and that a more efficient approach is to measure outcomes in terms of health year equivalents (HYEs). This paper explores the theoretical underpinning of this debate. It explores the claim that QALYs are liable to misrepresent consumer preferences and hence lead to decision-makers choosing options which are not those preferred by the public. It also considers the claim that HYEs do not suffer from this defect. We argue that none of the examples offered to date demonstrate the alleged tendency of QALYs to misinterpret preferences. We also suggest that although QALYs may misinterpret preferences in a way that HYEs do not, since they require that the individual’s utility function be additively separable over time, there is no evidence to date that QALYs do so.

Suggested Citation

  • Tony J Culyer & Adam Wagstaff, 1992. "QALYs versus HYEs - a theoretical exposition," Working Papers 099chedp, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:99chedp

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    References listed on IDEAS

    1. Torrance, George W., 1986. "Measurement of health state utilities for economic appraisal : A review," Journal of Health Economics, Elsevier, vol. 5(1), pages 1-30, March.
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    Cited by:

    1. Claude Le Pen, 1997. "Théorie de l'utilité et mesure des états de santé, le débat QALYs-HYEs," Économie et Prévision, Programme National Persée, vol. 129(3), pages 37-54.
    2. Andrew M Jones, 1995. "A microeconometric analysis of smoking in the UK health and lifestyle survey," Working Papers 139chedp, Centre for Health Economics, University of York.

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    QALY; HYE;


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