Quality-Adjusted Life Year (QALY) is used in cost analysis to measure the level of health in a patient.  Each person is given a number value 1.0 for perfect health decreasing to 0.0 equaling death.  “Some may argue that there are health states worse than death” (Waxman, 2013), and would require a negative value.  Who defines perfect health?  Many experts would relentlessly debate the inability to define perfect health.  I was unsuccessful in finding what definition is being used to measure perfect health for the Quality-Adjusted Life Year.  However, QALY determines a debilitating illness such as loss of limb, cancer, blindness, or use of wheelchair examples of a decrease in perfect health, therefore these patients would receive a rating between 0.0 and 1.0.  A patient may view and rank their level of health based on physical and mental factors such as pain and mental disabilities, and other factors that influence the patient and caregiver’s quality and quantity of life, yet these factors are not calculated in when determining the QALY (Waxman, 2013).

QALY is an attempt to evaluate the effect a change in a person’s health has on their quality of life depending on the burden of disease with or without treatment. Will treatment improve the individual’s life expectancy?  Patient preference, cost of treatment, life even if not in perfect health, and death are all outcomes requiring consideration when calculating QALY.  In Oncology this is an issue nurses, physicians and patients discuss daily.  Chemotherapy is a harmful chemical applied to the body, causing many harmful side effects, with no guarantee of remission.  There are times, when the patient’s age, stage of cancer, and other chronic illnesses may create a debate on what interventions are or should be used to treat the patients.  QALY is a way to rank the cost of intervention with the outcome of the patient during these times of difficult decision making. With the above-mentioned patient, the quantity of life may be extended by days or weeks, however is the quality of life worth the money spent for treatment, and the side effects experienced after treatment?  Due to limited resources, these life-saving treatments may be better used on a younger cancer patient with a better chance of survival, where not only the quantity but quality of life would be extended.  However, others argue this is an unfair and unethical distribution of the health care, and all patients should be given the opportunity for treatment including curative chemotherapy if they so choose.  QALY is controversial method of treatment in which a mathematical ratio is used to determine who will and who will not receive treatment based on cost, without any consideration of ethics or equality (Hickey & Brosnam, 2017).

References

Hickey, J. V., & Brosnam, C. A. (2017). Evaluation of health care quality. New York, NY: Springer.

Waxman, K. (2013). Financial and business management for the doctor of nurisng practice. New York, NY: Springer.