Establishing QALY weights for end of life

Project title: Establishing QALY weights for end of life (EQWEL)
Dates: December 2014 – December 2016
Funder: Chief Scientist Office
Project PI: Jose Luis Pinto Prades
Yunus Centre staff: Rachel Baker, Helen Mason, Cam Donaldson, Neil McHugh and also GCU staff Jon Godwin

Health Technology Assessment (HTA) agencies evaluate the costs and benefits of medicines (and other technologies) to make recommendations about the provision of healthcare. In the UK, a cost per quality-adjusted life year (QALY) threshold – £20,000-£30,000 per QALY – is used above which treatments are unlikely to be recommended. In 2009, the National Institute for Health and Care Excellence (NICE) introduced supplementary guidance making  life-extending, end-of-life (EoL) treatments, that met certain criteria an exception, to this threshold.  This implies that greater value is placed on gaining these QALYs, than QALYs gained by any other patient group treated for anything else in the health system, even for other EoL contexts (such as quality-of-life improvement alone).  However, empirical evidence of public preferences is equivocal for EoL health gains and limited for the value given to different types of EoL health benefits – in the form of both quality-of-life (QoL) improvement and life-extension (LE).  

We examine individual and societal preferences for health gains at the EoL relative to those from non-terminal health problems (Non-EoL) and for different types of EoL health gains.

Research Questions

1.Are preferences toward EoL treatments that increase life expectancy (EoL-LE) contingent upon the severity of the non-EoL comparator?

2.Are preferences for EoL treatments contingent upon the type of health gain, i.e. life expectancy vs quality of life?

3.Are preferences for EoL treatments contingent upon the preference elicitation method used, i.e. Willingness to Pay (WTP) vs. Person trade-off (PTO)?

4.Are WTP/PTO responses linked to underlying societal perspectives?