Meeting the Standards of Normal Science in Health Outcomes and Market ccess
Meeting the Standards of Normal Science in Health Outcomes and Market ccess
Meeting the Standards of Normal Science in Health Outcomes and Market Access for Pharmaceutical Products and Devices
Meeting the Standards of Normal Science in Health Outcomes and Market Access for Pharmaceutical Products and Devices

Abandoning QALYs

Abandoned, adj. left and no longer wanted, used or needed [There was an abandoned supermarket trolley in the middle of the road] OED

 

Should the QALY be abandoned? Unless health technology assessments can produce a QALY measure that conforms to the fundamental axioms of measurement theory of invariance and sufficiency, the answer is yes.

 

The QALY, a measure that is intended to combine mortality and morbidity, a global standard for assessing the cost-effectiveness of competing pharmaceutical products and devices, rests on a flimsy if not a fatally flawed base. It fails to meet the standards of normal science

 

The absence of scientific merit, the conclusion that lifetime QALYs are pseudoscience, sharing the Dover courtroom with intelligent design, is based on three considerations:

 

  • The QALY as centerpiece to claims by ICER on the construction of reference case imaginary worlds is nonsensical; imaginary ‘for approximate information’ constructs have no role in formulary decision making

     

  • Modeled claims for lifetime imaginary QALYs rests on the ability of the modelers to construct estimates of different time spent by hypothetical patients over their lifetimes in disease states to which utilities can be applied which again, fails to meet the standards of normal science

     

  • Utilities typically employed by model builders to generate QALYs (utility multiplied by time) are ordinal rather than cardinal measures, they fail standards for fundamental measurement; the resulting QALY ‘measure’ is logically absurd

 

Maimon Research can advise clients who presented with QALY and cost per QALY claims as to whether they meet the standards for scientific inquiry. If not, alternative claims frameworks can be proposed.

 

 

 

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