Current controversies of using cost per QALY for cost- effectiveness analysis-Isn’t two decades enough?

Abstract

Cost per quality-adjusted life year (QALY) has murky origins and is empirical by nature. The fundamental issue is that QALY is not aimed at valuing health improvements but rather valuing health states. In the present era of breakthrough innovations and personalized medicine, the cost per QALY approach is outdated and far too imprecise. Cost per QALY remains a golden standard for some health technology assessment agencies to determine the value for money of innovations. The method is associated with well-acknowledged shortcomings. Criticism to cost per QALY is steadily growing and echoed by experts and international organizations. Cost-effectiveness analyses are expected to be expressed as costs per relevant clinical outcome and integrate fairly all relevant attributes. Cost per QALY assessment for health decision-making played its role in the last decades but should be abandoned in light of the current knowledge and nature of new medical technologies.