Logical Inconsistencies in the Health Years in Total and Equal Value of Life-Years Gained
Objectives This study aimed to assess whether recently proposed alternatives to the quality-adjusted life-year (QALY), intended to address concerns about discrimination, are suitable for informing resource allocation decisions. Methods We consider 2 alternatives to the QALY: the health years in total (HYT), recently proposed by Basu et al, and the equal value of life-years gained (evLYG), currently used by the Institute for Clinical and Economic Review. For completeness we also consider unweighted life-years (LYs). Using a hypothetical example comparing 3 mutually exclusive treatment options, we consider how calculations are performed under each approach and whether the resulting rankings are logically consistent. We also explore some further challenges that arise from the unique properties of the HYT approach. Results The HYT and evLYG approaches can result in logical inconsistencies that do not arise under the QALY or LY approaches. HYT can violate the independence of irrelevant alternatives axiom, whereas the evLYG can produce an unstable ranking of treatment options. HYT have additional issues, including an implausible assumption that the utilities associated with health-related quality of life and LYs are “separable,” and a consideration of “counterfactual” health-related quality of life for patients who are dead. Conclusions The HYT and evLYG approaches can result in logically inconsistent decisions. We recommend that decision makers avoid these approaches and that the logical consistency of any approaches proposed in future be thoroughly explored before considering their use in practice.
Citation
@article{m.2024,
author = {Paulden, M. and Sampson, C. and O’Mahony, J. F. and
Spackman, E. and McCabe, C. and Round, J. and Snowsill, T.},
title = {Logical {Inconsistencies} in the {Health} {Years} in {Total}
and {Equal} {Value} of {Life-Years} {Gained}},
journal = {Value in Health},
volume = {27},
number = {3},
pages = {356-366},
date = {2024},
url = {https://tristansnowsill.co.uk/publications/2024/logical-inconsistencies-in-the-health-years-in-total.html},
doi = {10.1016/j.jval.2023.11.009},
langid = {en},
abstract = {**Objectives** This study aimed to assess whether recently
proposed alternatives to the quality-adjusted life-year (QALY),
intended to address concerns about discrimination, are suitable for
informing resource allocation decisions. **Methods** We consider 2
alternatives to the QALY: the health years in total (HYT), recently
proposed by Basu et al, and the equal value of life-years gained
(evLYG), currently used by the Institute for Clinical and Economic
Review. For completeness we also consider unweighted life-years
(LYs). Using a hypothetical example comparing 3 mutually exclusive
treatment options, we consider how calculations are performed under
each approach and whether the resulting rankings are logically
consistent. We also explore some further challenges that arise from
the unique properties of the HYT approach. **Results** The HYT and
evLYG approaches can result in logical inconsistencies that do not
arise under the QALY or LY approaches. HYT can violate the
independence of irrelevant alternatives axiom, whereas the evLYG can
produce an unstable ranking of treatment options. HYT have
additional issues, including an implausible assumption that the
utilities associated with health-related quality of life and LYs are
“separable,” and a consideration of “counterfactual” health-related
quality of life for patients who are dead. **Conclusions** The HYT
and evLYG approaches can result in logically inconsistent decisions.
We recommend that decision makers avoid these approaches and that
the logical consistency of any approaches proposed in future be
thoroughly explored before considering their use in practice.}
}