An alternative to QALYs: the saved young life equivalent (SAVE)

Quality adjusted life years (QALYs) are based on the concept that the effectiveness of a health care programme is greater the more significant the health improvements it provides, the longer the patients get to enjoy the improvements, and the more patients who are helped.'`4 The concept is put into practice in the so called health status index approach: life years in different states of illness or dysfunction are assigned values on a scale of 1-0 (healthy) to 0.0 (dead). The values reflect the quality of the states and allow morbidity and mortality improvements to be combined into a single weighted measure-that is, QALYs gained. For example, if a programme improves the health of individual A from 0 5 to 0 8 for one year and extends the life of individual B for five years in a 0-6 state, then a total of 3-3 QALYs will be gained ((0 8-0 5)+(5OxO6)=3 3). Cost per QALY gained (the so called "cost:utility ratio") may be calculated for different programmes. When prioritising between them the standard health economist recommendation is to rank the programmes from the lowest cost per QALY value to the highest and to select from the top until available resources are exhausted.'6 This paper argues that the health status index approach and the focusing on life years as units of measurement are main causes of public resentment against QALYs.7-'3 A more direct procedure is outlined for assessing the social value of health care. Like QALYs it allows comparisons of different health care programmes in terms of cost:utility ratios.