QALYS AND MENTAL-HEALTH-CARE

Quality-adjusted life year measures (QALYs) have been fervently debate d by researchers and decision makers concerned with resource allocatio n in the health care sector. They have been heralded as important aids to planning and priority setting, but also criticised on technical an d ethical grounds. This paper examines these arguments with special re ference to mental health care, the intention being to highlight the st rengths and shortcomings of QALYs in this context. Issues pertinent to the application of QALYs in health care evaluation more generally are also reviewed. Whilst the rationale and underlying principles of the utility measurement approach are sound, the generic QALY as it is curr ently constructed represents an insensitive measure of the outcomes of mental health care. In the event of an increasingly QALY-driven prior ity-setting environment, however, abandonment of QALYs runs the risk o f inappropriately marginalising people with mental illnesses in the re source allocation process. This opens up the possibility of developing a mental-health specific measure of utility that, in combination with cost data, would provide useful and appropriate summary information a cross treatments and programmes of mental health care.