QALY CONCEPT

QALY Concept

QALY Concept

Introduction

QALY is the acronym of English "Quality Adjusted Life Year" or “years of life adjusted for its quality.” This economic indicator to estimate the value of life was proposed in 1977 by Weinstein and Stason. It comes from the application to the public health of the utility theory in economics, and can be compared with another indicator used by the WHO, the life expectancy DALY (DALY in English, Disability-adjusted life year). The QALY can be used to assess the monetary value of an intervention or therapeutic treatment. A healthy year is a QALY of 1; intervention causing death is a QALY 0; a year in which therapeutic intervention can prolong life expectancy by affecting any actual living conditions (e.g. avoiding death at the cost of disability) will be between 0 and 1.

The use of QALYs as an indicator is controversial. Economists like Alan H. Williams, a former professor at the Centre for Health Economics from the University of York, expressed broad support for its use. Williams has been responsible for the creation of the National Institute for Clinical Excellence (en) (NICE), a British organization that uses this criterion. Others, like John Harris, the first philosopher to have been co-opted within the Academy of Medical Sciences (in) and editor in chief of The Journal of Medical Ethics (in), have strongly criticized the contrary. The first part contains a series of theoretical considerations on QOL.

A. We distinguish three taxonomies of QOL: QOL QOL objective versus subjective QOL at macro, meso and micro levels, and overall QOL (overall quality of life) versus QOL in facets.

1. The separate use of objective and subjective factors when measuring QOL has drawbacks. Their combination can resolve this and is theoretically defensible. Poor objective situation does not mean that the subjective evaluation of the patient is poor (eg QOL of end-stage cancer may be poor because of the weakness of his health from a objective point of view, while subjective QOL can be high due to the overall care quality). In the same vein, a good objective situation is not a guarantee for a high subjective assessment (eg QOL a high score with a mastectomy, which went smoothly from one point of view medical, but it can be distressing to the patient). It is important to resume objective and subjective elements in research. The relationship between objective and subjective parameters, however, does not much studied. Indications of a problematic relationship between these parameters are yet quite numerous. Research shows that a patient's QOL determined by a physician is often different from the same patient QOL determined by a nurse / nurse and that QOL is evaluated differently even by the patient himself.

2. There are three levels of research on QOL. QOL research is the subject of macro. We study the societal level a number of QOL variables such as health, housing, education, income ... These searches are performed at present mainly in third world countries, where we want to see clearly the impact of policy measures ...