Retaining, and enhancing, the QALY.

For economic and policy analyses requiring a summary health outcome measure that integrates quantity-of-life and quality-oflife impacts, the quality-adjusted life-year (QALY) has been widely recognized and endorsed [1–3]. The US Panel on Cost-Effectiveness in Health and Medicine recommended the QALY for “reference case” analyses [2]. The UK National Institute for Health and Clinical Excellence (NICE) regularly uses QALYs in its technology appraisals [3]. Regulatory and purchasing agencies in several other European nations, Canada, and Australia likewise recognize the use of QALYs in analyses of whether medical products and interventions offer good value for money [4]. The enthusiasm with which analysts from academia and contract research organizations embrace the QALY in economic evaluations is evident from a quick review of the leading health policy evaluation journals or the roster of presentations at any recent ISPOR Annual International Meeting [5]. As a point of reference for much of the discussion that follows, it is useful to define at the outset what we term the conventional QALY: