THE USE OF QALY AND NON-QALY MEASURES OF HEALTH-RELATED QUALITY-OF-LIFE ASSESSING THE STATE-OF-THE-ART

There are now a large number of instruments available for assessing he alth-related quality of life, many of which are used within economic e valuations. When considering the use of quality-of-life instruments, m eaningful questions need to be asked to determine whether an instrumen t has been used judiciously. Such questions should consider whether th e instrument is valid and suitable for the particular study question, whether the instrument is compatible with the economic evaluation fram ework used, and subsequently whether the conclusions presented in the study are legitimate. In order to illustrate the value of these questi ons we have applied them to a number of economic evaluations. The stud ies used were identified via a systematic review of the health economi cs literature. In our assessment of a sample of published material, we found that reporting is frequently unhelpful and that the inappropria te use of instruments and techniques casts doubt on the conclusions of economic evaluations. Furthermore, our systematic review of the healt h economics literature has shown that the general format of reported e conomic evaluations falls short of the commonly accepted ideal. We exa mined the health economics literature for 1995 and only identified a h andful of studies which satisfied the economic evaluation criteria as accepted by most economists. It is hoped that raising awareness of the se issues will urge evaluators, referees and publishers not to lose si ght of the needs of the decision-maker when considering the detail whi ch should be present in a reported evaluation.