ArticlePharmacoEconomics2015
Validation of the underlying assumptions of the quality-adjusted life-years outcome: results from the ECHOUTCOME European project.
Article in PharmacoEconomics, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 63 citations in OpenAlex.
- The quality of economic evaluations of ultra-orphan drugs in Europe - a systematic review.Orphanet journal of rare diseases · 2015Pooled it
- Balancing costs and benefits at different stages of medical innovation: a systematic review of Multi-criteria decision analysis (MCDA).BMC health services research · 2015Pooled it
- Cost-analysis and quality of life after laparoscopic and robotic ventral mesh rectopexy for posterior compartment prolapse: a randomized trial.Techniques in coloproctology · 2019Trial
- Guidelines for the use of economic evaluation to inform policies around access to treatment for kidney failure.Nature reviews. Nephrology · 2025Review
- How Patients Can Contribute to the Assessments of Health Technologies.Journal of market access & health policy · 2025Article
- Reevaluating health metrics: Unraveling the limitations of disability-adjusted life years as an indicator in disease burden assessment.World journal of methodology · 2025Review
- Impact of illness and death: comparison of Load and QALY models.BMJ open quality · 2025Article
- How Much Better is Faster? Empirical Tests of QALY Assumptions in Health-Outcome Sequences.PharmacoEconomics · 2025Article
- New Anticancer Drugs: Reliably Assessing "Value" While Addressing High Prices.Current oncology (Toronto, Ont.) · 2024Article
- One Step Ahead in Realizing Pharmacogenetics in Low- and Middle-Income Countries: What Should We Do?Journal of multidisciplinary healthcare · 2024Review
- Optimizing Diabetes Management Using a Low-Calorie Diet in Saudi Arabia: A Cost-Benefit Analysis.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2024Article
- How Much Better is Faster? Value Adjustments for Health-Improvement Sequences.PharmacoEconomics · 2023Article
- Alternatives to the quality-adjusted life year: How well do they address common criticisms?Health services research · 2023Article
- Assessing the value of delandistrogene moxeparvovec (SRP-9001) gene therapy in patients with Duchenne muscular dystrophy in the United States.Journal of market access & health policy · 2023Article
- Expenditures and Healthcare Utilization of Patients Receiving Care at a Specialized Primary Care Clinic Designed with and for Autistic Adults.Journal of general internal medicine · 2022Article
- Measurement, modeling and QALYs.F1000Research · 2020Article
- Determining Value in Health Technology Assessment: Stay the Course or Tack Away?PharmacoEconomics · 2019Article
- Immuno-Oncology Medicines: Policy Implications and Economic Considerations.Innovations in pharmacy · 2019Review
- Does the Addition of Either a Lateral or Posterior Interbody Device to Posterior Instrumented Lumbar Fusion Decrease Cost Over a 6-Year Period?Global spine journal · 2018Article
- Pluripotent Stem Cells for Retinal Tissue Engineering: Current Status and Future Prospects.Stem cell reviews and reports · 2018Review
Corrections and comments
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Authors and funding
10 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundQuality-adjusted life-years (QALYs) have been used since the 1980s as a standard health outcome measure for conducting cost-utility analyses, which are often inadequately labeled as 'cost-effectiveness analyses'. This synthetic outcome, which combines the quantity of life lived with its quality expressed as a preference score, is currently recommended as reference case by some health technology assessment (HTA) agencies. While critics of the QALY approach have expressed concerns about equity and ethical issues, surprisingly, very few have tested the basic methodological assumptions supporting the QALY equation so as to establish its scientific validity.
objectivesThe main objective of the ECHOUTCOME European project was to test the validity of the underlying assumptions of the QALY outcome and its relevance in health decision making.
methodsAn experiment has been conducted with 1,361 subjects from Belgium, France, Italy, and the UK. The subjects were asked to express their preferences regarding various hypothetical health states derived from combining different health states with time durations in order to compare observed utility values of the couples (health state, time) and calculated utility values using the QALY formula.
resultsObserved and calculated utility values of the couples (health state, time) were significantly different, confirming that preferences expressed by the respondents were not consistent with the QALY theoretical assumptions.
conclusionsThis European study contributes to establishing that the QALY multiplicative model is an invalid measure. This explains why costs/QALY estimates may vary greatly, leading to inconsistent recommendations relevant to providing access to innovative medicines and health technologies. HTA agencies should consider other more robust methodological approaches to guide reimbursement decisions.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.