The quality-adjusted life-year (QALY) has come under fire lately. In the United States, health reform legislation prohibited use of cost-per-QALY thresholds.1 The United Kingdom has proposed that the National Institute for Health and Clinical Excellence (NICE), which has influenced reimbursement through cost-per-QALY ratios, will not in the future use such information to make yes or no recommendations; instead NICE's cost-effectiveness assessments would provide an input into price negotiations for technologies.2 In Germany, the Institute for Quality and Efficiency in Health Care implemented a new system for evaluating the value of medical technologies but rejected the cost-per-QALY model on ethical and methodological grounds.3 Many countries (including France, Spain, and Italy) have opted for other approaches. Other articles have criticized use of QALYs.4,5
Neumann PJ. What Next for QALYs?. JAMA. 2011;305(17):1806–1807. doi:10.1001/jama.2011.566
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