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Using QALYs in Cancer: Review of the Methodological Limitations


  • Garau, M.
  • Shah, K.
  • Mason, A.R
  • Wang, Q.
  • Towse, A.
  • Drummond, M.F


Current methods for constructing quality adjusted life year (QALY) measurements may be deficient for cancer patients in three respects - descriptions of health state, valuation of health state, and the source of values upon which measures are based. Existing measures of health are either not sensitive enough or not attuned to cancer patients' actual preferences. For example, evidence suggests that the EQ 5D instrument does not capture the small changes in health that often are very important to cancer patients. Valuation of health states for cancer patients using traditional methods also encounters problems. For example, the time trade-off (TTO) method assumes that the rate at which people are willing to trade life expectancy for improvements in quality of life is the same under all circumstances. Research has shown otherwise, however, for the severely ill. Whose values form the basis of health state valuations also matters. Using the general public to value health states may overvalue interventions aimed at achieving perfect health and undervalue those aimed at prolonging life or achieving small improvements in health-related quality of life. The research proposes three possible ways forward, given these concerns. A revised version of this paper has been published in PharmacoEconomics and can be downloaded from - Please cite as - Garau, M., Shah, K.K., Mason, A.R., Wang, Q., Towse, A. and Drummond, M.F., 2011. Using QALYs in cancer. Pharmacoeconomics, 29(8), pp.673-685.

Suggested Citation

  • Garau, M. & Shah, K. & Mason, A.R & Wang, Q. & Towse, A. & Drummond, M.F, 2010. "Using QALYs in Cancer: Review of the Methodological Limitations," Research Papers 000211, Office of Health Economics.
  • Handle: RePEc:ohe:respap:000211

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    Cited by:

    1. David Feeny, 2013. "Standardization and Regulatory Guidelines May Inhibit Science and Reduce the Usefulness of Analyses Based on the Application of Preference-Based Measures for Policy Decisions," Medical Decision Making, , vol. 33(3), pages 316-319, April.
    2. Pinto-Prades, Jose-Luis & Sánchez-Martínez, Fernando-Ignacio & Corbacho, Belen & Baker, Rachel, 2014. "Valuing QALYs at the end of life," Social Science & Medicine, Elsevier, vol. 113(C), pages 5-14.
    3. Shah, Koonal K. & Tsuchiya, Aki & Wailoo, Allan J., 2015. "Valuing health at the end of life: A stated preference discrete choice experiment," Social Science & Medicine, Elsevier, vol. 124(C), pages 48-56.
    4. Aris Angelis & Panos Kanavos, 2016. "Value-Based Assessment of New Medical Technologies: Towards a Robust Methodological Framework for the Application of Multiple Criteria Decision Analysis in the Context of Health Technology Assessment," PharmacoEconomics, Springer, vol. 34(5), pages 435-446, May.
    5. Garau, M. & Towse, A. & Garrison, L. & Housman, L. & Ossa, D., 2012. "Can and Should Value Based Pricing Be Applied to Molecular Diagnostics?," Research Papers 000160, Office of Health Economics.
    6. James D. Chambers & Teja Thorat & Colby L. Wilkinson & Mark Salem & Prasun Subedi & Sachin J. Kamal-Bahl & Peter J. Neumann, 2017. "Estimating Population Health Benefits Associated with Specialty and Traditional Drugs in the Year Following Product Approval," Applied Health Economics and Health Policy, Springer, vol. 15(2), pages 227-235, April.
    7. SeungJin Bae & SooOk Lee & Eun Bae & Sunmee Jang, 2013. "Korean Guidelines for Pharmacoeconomic Evaluation (Second and Updated Version)," PharmacoEconomics, Springer, vol. 31(4), pages 257-267, April.
    8. Angelis, Aris & Kanavos, Panos, 2016. "Value-based assessment of new medical technologies: towards a robust methodological framework for the application of multiple criteria decision analysis in the context of health technology assessment," LSE Research Online Documents on Economics 65148, London School of Economics and Political Science, LSE Library.
    9. Mathilda Bongers & Veerle Coupé & Elise Jansma & Egbert Smit & Carin Groot, 2012. "Cost Effectiveness of Treatment with New Agents in Advanced Non-Small-Cell Lung Cancer," PharmacoEconomics, Springer, vol. 30(1), pages 17-34, January.

    More about this item


    Judging value for money and improving decision making;

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health


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