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NHS treatment decisions 'seriously flawed'
25th January 2013 - A formula for deciding which medications and other treatments should be available on the NHS is flawed, according to a study funded by the European Commission. What is the formula, why is it used and why do some experts dispute its value? Read our FAQs.
What formula is used in the UK?
The formula is called Quality Adjusted Life Years (QALY) and is used by The National Institute for Health and Clinical Excellence (NICE) in deciding which new medications and other treatments should be made available on the NHS in England and Wales. A similar system is used in Scotland by the Scottish Medicines Consortium (SMC).
The QALY is a formula calculated from predicted life expectancy and a measure of the health-related quality of the remaining life-years.
Each year in perfect health is assigned the value of 1.0, down to a value of 0.0 for being dead. Years not lived in full health are given a value between 0 and 1 to account for this.
There are many different ways to calculate quality of life. A number of factors are considered including the level of pain the person is in, their mobility and their general mood.
Usually, if the cost per QALY gained by a treatment is below £30,000, the treatment is made available on the NHS.
Do other countries use QALY?
Yes, the system is also in use in Canada and Australia.
Several other European countries are considering adopting the formula.
Why do the European researchers say it is flawed?
The European Commission funded research project highlights what it calls "huge failings" in the way that NICE and similar agencies in other countries decide which treatments should be made available.
It says the four assumptions made in the QALY method are flawed. These are:
- Time and quality of life can be measured in consistent intervals. Research found that, while this is true for measuring the time that a patient is expected to live, quality of life is personal and different people rank different conditions as having a greater or worse impact.
- Life years and quality of life are linked. The experts say this assumes that someone who prefers 10 years of healthy life to five years will also prefer 10 years in a wheelchair to five years. The results showed that this does not reflect how real people feel.
- People are neutral about risk. The researchers found that patients are usually either willing to take risks or are risk averse. The assumption that people are neutral can lead to decisions which completely distort the desires of patients, they say.
- Willingness to sacrifice life years is constant over time. This assumption suggests an individual willing to trade off five years in a remaining 25 years (20% of life) for better health, will also give up two years in 10. The experts say that research showed that willingness to sacrifice time for life quality over different periods of time varied enormously.