The social value of a QALY: raising the bar or barring the raiseReport as inadecuate

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BMC Health Services Research

, 11:8

First Online: 11 January 2011Received: 15 December 2009Accepted: 11 January 2011DOI: 10.1186-1472-6963-11-8

Cite this article as: Donaldson, C., Baker, R., Mason, H. et al. BMC Health Serv Res 2011 11: 8. doi:10.1186-1472-6963-11-8


BackgroundSince the inception of the National Institute for Health and Clinical Excellence NICE in England, there have been questions about the empirical basis for the cost-per-QALY threshold used by NICE and whether QALYs gained by different beneficiaries of health care should be weighted equally. The Social Value of a QALY SVQ project, reported in this paper, was commissioned to address these two questions. The results of SVQ were released during a time of considerable debate about the NICE threshold, and authors with differing perspectives have drawn on the SVQ results to support their cases. As these discussions continue, and given the selective use of results by those involved, it is important, therefore, not only to present a summary overview of SVQ, but also for those who conducted the research to contribute to the debate as to its implications for NICE.

DiscussionThe issue of the threshold was addressed in two ways: first, by combining, via a set of models, the current UK Value of a Prevented Fatality used in transport policy with data on fatality age, life expectancy and age-related quality of life; and, second, via a survey designed to test the feasibility of combining respondents- answers to willingness to pay and health state utility questions to arrive at values of a QALY. Modelling resulted in values of £10,000-£70,000 per QALY. Via survey research, most methods of aggregating the data resulted in values of a QALY of £18,000-£40,000, although others resulted in implausibly high values. An additional survey, addressing the issue of weighting QALYs, used two methods, one indicating that QALYs should not be weighted and the other that greater weight could be given to QALYs gained by some groups.

SummaryAlthough we conducted only a feasibility study and a modelling exercise, neither present compelling evidence for moving the NICE threshold up or down. Some preliminary evidence would indicate it could be moved up for some types of QALY and down for others. While many members of the public appear to be open to the possibility of using somewhat different QALY weights for different groups of beneficiaries, we do not yet have any secure evidence base for introducing such a system.

List of abbreviationsDfTDepartment for Transport

PTOPerson trade-off

QALYQuality adjusted life year

NHSNational Health Service

NICENational Institute for Health and Clinical Excellence

SVQSocial Value of a QALY

VPFValue of a prevented fatality

VSIValue of a serious injury

WTPWillingness to pay

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Author: Cam Donaldson - Rachel Baker - Helen Mason - Michael Jones-Lee - Emily Lancsar - John Wildman - Ian Bateman - Graham Loome


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