Does adjusting for health-related quality of life matter in economic evaluations of cancer-related interventions?

Abstract

Aims: We investigated the extent to which adjusting for health-related quality of life (HRQoL) alters incremental cost per life-year gained ratios, and the implications for reimbursement decisions. Methods: We identified all cancer-related interventions in the Tufts Medical Center Cost–Effectiveness Analysis Registry in which both a cost/quality-adjusted life-year (QALY) and a cost/life-year ratio were reported in the same study. We assessed the ordinal relationship between these ratios and analyzed the extent to which using a cost/QALY rather than a cost/life-year ratio would potentially yield different reimbursement decisions. Results: The rank–order correlation between cost/life-year and cost/QALY ratio pairs was 0.917 (p < 0.0001). In 78.8% of comparisons, both cost/QALY and cost/life-year ratios were below a prespecified threshold (e.g., US$50,000 per QALY or life-year). Adjusting for HRQoL resulted in a higher ratio such that it crossed a prespecified threshold in 18.6% of interventions. The data suggest that adjusting life-years for HRQoL does not substantively affect cost per life-year ratios for the vast majority of cancer-related interventions. Conclusion: Our analysis implies that the method used for HRQoL adjusting or even HRQoL adjusting at all does not matter for most reimbursement decisions on life-saving interventions. The results could differ for interventions that have large impacts on patients’ HRQoL compared with the impact on survival.

Keywords::

• cancer
• cost–effectiveness analysis
• health-related quality of life
• life-year gained
• QALY
• reimbursement

Acknowledgement

An earlier version of this study has been presented in an abstract form at the ISPOR 12th Annual European Congress, Paris, 24–27 October 2009.

Financial & competing interests disclosure

The Cost–Effectiveness Analysis Registry upon which this research is based has been funded by a number of sources, including most recently the National Library of Medicine (1G08LM008413). In addition, the Cost–Effectiveness Analysis Registry receives unrestricted funding from a number of pharmaceutical industry sponsors, who are listed on our website: www.cearegistry.org. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.