Is there an alternative to quality-adjusted life years for supporting healthcare decision making?

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Abstract
Introduction: Over the years, a number of criticisms have been raised about the robustness of the Quality-Adjusted Life Years (QALY) indicator and its use in cost-utility analyses; however, costs/QALY are still nowadays recommended as reference case by several Health Technology Assessment (HTA) agencies from some Commonwealth countries, such as the National Institute for Health and Care Excellence (NICE) in the UK, claiming that no alternatives exist to allocate health care resources. Areas covered: This review presents a selection of robust alternative methodologies that could be used to support HTA decisions more accurately and more fairly than using the QALYs, including for determining the level of patient access and reimbursement coverage to healthcare interventions. Expert commentary: Because of the scientific complexity of the situations raised by existing and innovative health technologies and interventions, there is currently no single alternative paradigm to propose at this time, but a spectrum of additional analytical techniques which could handle various outcomes including costs and health consequences, and which are not based on a simple multiplicative formula.

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