COST-PER-QALY LEAGUE TABLES - THEIR ROLE IN PHARMACOECONOMIC ANALYSIS

It has become common for analysts to present the findings of cost-util ity analyses in cost per quality-adjusted life-year (QALY) league tabl es or rankings. These purport to show the relative value-for-money of different healthcare technologies. Concomitantly, there is an increasi ng market for cost-effectiveness data worldwide. However, the practice of constructing league tables has drawn criticism. Claims of inapprop riate comparisons, and poor and flawed methodology have been made. How should decision-makers view cost/QALY league tables? In future, publi shed league tables will need to be more informative and thus, by neces sity, complex. The principal obstacle to informing health policy-maker s with economic analysis is the lack of appropriate outcome data. From this follows uncertainty as to what represents acceptable value-for-m oney in healthcare purchasing. Thus, the long term objective must be t o obtain valid assessments of the value of current and new health serv ice activities. It is in this context that league tables may eventuall y be most helpful. More immediately, a strategy is required to help de cision-makers to prioritise resources rationally with incomplete infor mation.