The Impact of Time Horizons on QALY Calculations in Healthcare
By Melike Belenli Gümüş
June 10, 2024
Introduction
Quality-adjusted life years (QALYs) play a pivotal role in determining the cost-effectiveness of treatments, particularly within the National Health Service (NHS) of England and Wales. While theoretically equal, the practical application of QALYs has raised concerns, especially regarding rare diseases and unique patient populations. This article explores the impact of time horizons on QALY calculations and implicitly funding decisions for healthcare treatments.
Understanding QALYs and NICE’s Evaluation
QALYs blend clinical benefit and treatment duration, with the National Institute for Health and Care Excellence (NICE) using them to assess cost-effectiveness. Treatments exceeding GBP 30,000 per QALY gained face funding challenges. However, the application of QALYs across diverse patient groups has sparked debates on fairness and transparency in decision-making processes.
Figure 1: The concept of Quality-adjusted life years (QALYs) combines the clinical benefit of a treatment with the time duration over which the patient benefits. Longer time horizons result in the accumulation of more QALYs. For instance, in a scenario where Treatment A has a quality of life of 0.8 over 40 years and Treatment B has a quality of life of 0.4 over 80 years, both treatments yield the same QALY gain.
Case Studies: Afamelanotide and Givosiran
Examining evaluations of afamelanotide for erythropoietic protoporphyria and givosiran for acute hepatic porphyria reveals discrepancies in time horizons. The length of time considered for treatment impacts QALY gains and subsequent funding recommendations, highlighting the need for consistency and realism in assessments.
Figure 2: Treatment duration in the clinical reality vs. time horizon used to calculate the QALY gain of afamelanotide for treating erythropoietic protoporphyria (above) and givosiran for treating acute hepatic porphyria (below) at NICE.
Analysis of Time Horizons in HST Programme
A comprehensive review of time horizons in Highly Specialised Technologies (HST) evaluations uncovers a trend towards extended durations, sometimes surpassing expected treatment periods or life expectancies. Extended time horizons can alter perceived treatment benefits and impact funding decisions, potentially influencing resource allocation within the healthcare system.
Implications and Recommendations
The study underscores the importance of aligning time horizons with clinical realities to ensure equitable funding decisions. Transparent reporting and methodological consistency in QALY calculations are crucial for promoting fairness and trust in healthcare funding processes. Addressing discrepancies and rationalising parameters like time horizons can enhance the integrity of decision-making frameworks.
Conclusion
The analysis calls for a re-evaluation of time horizons in QALY calculations to uphold fairness and accuracy in healthcare funding assessments. By fostering transparency, consistency, and evidence-based decision-making, organisations like NICE can better serve diverse patient populations and uphold the principles of equitable healthcare access.
💡 *What happens when a country decides to withdraw from global health organizations?*
Argentina’s President Javier Milei has made the bold move to withdraw from the WHO, citing significant disagreements over health management during the pandemic. This decision raises questions about national sovereignty, cooperation, and the future of global health initiatives. Dive into the implications of Argentina’s stance and what it means for international health governance.
💉 Ready to protect our future generations from cervical cancer?
The Gauteng HPV vaccination campaign aims to vaccinate grade 5, 6, and 7 girls against the virus that causes most cervical cancers. By leveraging a single-dose regimen, this initiative not only enhances access to life-saving vaccines but also strives to meet ambitious global health targets.
Explore how this campaign is reshaping health outcomes in South Africa and why parental consent is key to its success.
🌍 What if a single vaccine could significantly change the landscape of pneumococcal disease prevention in adults?
The European Medicines Agency has just recommended Merck’s Capvaxive, an innovative 21-valent pneumococcal conjugate vaccine! With robust data from multiple phase 3 trials, this potential approval marks a pivotal step in the fight against invasive Streptococcus pneumoniae infections in the EU. Look into how Capvaxive could enhance public health outcomes and offer extensive serotype coverage.
#SyenzaNews #pharmaceuticals #healthcarepolicy
When you partner with Syenza, it’s like a Nuclear Fusion.
Our expertise are combined with yours, and we contribute clinical expertise and advanced degrees in
health policy, health economics, systems analysis, public finance, business, and project management.
You’ll also feel our high-impact global and local perspectives with cultural intelligence.
