QALYS OR NOT QALYS - THAT IS THE QUESTION

The article discusses the proposal of some health economists to use th e ''cost per QALY (quality-adjusted-life year)'' ratio as an universal indicator for economic assessment of medical interventions, in the so -called ''cost-utility'' analyses. Authors argue that QALYs are not a straightforward application of expected utility theory, which is the s tandard economic model of individual behaviours toward risk and uncert ainty. Indeed, QALYs are compatible with economic utility theory only if individuals' preferences regarding health states satisfy certain ve ry restrictive properties utility independence between length of life and quality of life, constancy of the proportional trade-off between q uality of life and length of life, risk neutrality towards health stat es, constancy through time of the utility associated with each health state. Agregation of individual QALYs to obtain an indicator for patie nt groups at the societal level also raises complex equity problems. L ast but not least, from the epistemological point of view, QALYs are b ased on the hypothesis that health interventions only affect the healt h of the individual and not any other aspects of his well-being. The a uthors conclude that the ''cost per QALY'' approach should be abandone d in order to avoid ambiguities that could impede the development of h ealth economics in the medical field.