EC-funded research project throws doubt on NHS method of assessing treatment options

25 Jan

 UK gets cold shoulder from Europe over attempt to share its treatment selection process.

 The European Consortium in Healthcare Outcomes and Cost-Benefit research (ECHOUTCOME) has released a report criticising the model used by the UK’s National Institute of Clinical Excellence (NICE) to select the most appropriate treatment for conditions. ECHOUTCOME project leader and CEO of Data Mining International Ariel Beresniak asserted “robust scientific evidence” proved that “QALYs produce hugely inconsistent, wrong results, on which important decisions are being made.”

 The Quality Adjusted Life Years (QALY) approach is an economic theory which mathematically weighs the number of life years, and improvement to quality of life, by comparing different treatments to make recommendations as to the most effective. Its dogmatic adherence to its four central precepts has been criticised for failing to take account of patients’ divergent approaches to factors like risk associated with each treatment, and the relative ‘quality’ of healthy life compared to life in a wheelchair.

 In the UK, if the incremental cost per QALY (cost of one additional year in perfect health) is below £30,000 then the option is usually recommended to be accessible to patients. However, researchers point to a recent case where a new treatment for rheumatoid arthritis, which several other QALY assessments had rated as cost-effective, was discounted on the basis of one negative QALY result. Ruling out an alternative therapy in this way could be short-sighted if the drugs currently in use become less effective or cause side-effects.

 

Alastair Kent, Director of Genetic Alliance UK, a group working to improve the lives of people

affected by genetic conditions, says: “We recognise that there is a limited budget and tough

decisions to be made. But the QALY system in its current form is an inadequate, incomplete measure

which neglects important issues. Any system for allocating medical resources must carry confidence

of clinicians, patients and society at large, and the current system does not.”

 

The research surveyed 1,300 respondents in Belgium, France, Italy and the UK, and is the largest investigation into QALYs ever undertaken. It demonstrated a range of divergent responses to the QALYs four key assumptions, which hold that:

1.     1.   Time and quality of life can be measured in consistent intervals. Quality is subjective and different people rank conditions as having relatively greater or less impact.

2.    2.    Life years and quality of life are linked. This assumes someone who prefers ten years of healthy life to five years will also prefer ten years in a wheelchair to five years.

3.   3.    People are neutral about risk. Results show that they are actually polarised in their attitudes – either very risk averse or disregarding potential risk.

4.     4.   Willingness to sacrifice life years is constant over time. This assumes an individual is willing to trade off a remaining 25 years (20% of life) for better health, but that they will similarly give up two years in ten. In fact, willingness to sacrifice time for life quality varies according to the length of the time period.

Gerard Duru, Emeritus Research Director in Mathematics at the French National Centre of Scientific research (CNRS) said: “The underlying assumptions of the QALY outcome are very theoretical and are not verified in a real population. The QALY indicator is not a valid scientific scale. It is impossible to know what we are measuring, and therefore impossible to base a formula upon it. To be able to trust this formula, all four of these assumptions must be validated. If they aren’t we don’t have the right to use it.”

Experts suggest an approach that is less doctrinaire and more reactive to circumstance and each individual case.

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ECHOUTCOME (European Consortium in Healthcare Outcomes and Cost-Benefit research) is made up of experts in healthcare, mathematics and economics from Data Mining International (Switzerland – Project leader), the University of Bocconi (Italy), the Université Libre de Bruxelles (Belgium), the French Society of Health Economics (SFES), Cyklad Group (France), Lyon Ingénierie Projets and the Claude Bernard University (France).

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