Cost per quality-adjusted life year and disability-adjusted life years: the need for a new paradigm

Abstract

Two different paradigms have been proposed for setting priorities for access to healthcare: cost per quality-adjusted life year based on interventions, and disability-adjusted life years based on the burden of disease in a population. These formal paradigms make explicit the assumptions made implicitly every day in delivering and hence rationing access to healthcare. This paper outlines each paradigm’s methodological problems and argues that each paradigm is incomplete in terms of providing the information necessary for making budgetary decisions on healthcare. It argues that a scientific revolution is required to create a new paradigm by combining the strengths of each.

• avoidable disability-adjusted life
• years (avoidable DALYs)
• burden of disease
• cost-effectiveness
• cost per quality-adjusted life year (cost\QALY)
• disability-adjusted life year (DALY)
• economic evaluation
• needs assessment
• priority setting
• quality-adjusted life year (QALY)
• rationing