ABSTRACT
The quality-adjusted-life-year (QALY) approach is ambitious, particularly if it is intended to provide the basis for allocating resources between specialisms, rather than between procedures within the same specialism. In the design of that process, there is a tension between the number of states identified for valuation, which determines the sensitivity of the QALY measure, and the complexity of the valuation task. The sensitivity of the scale depends on the number of health states, and the greater the number of health states, the more complex valuation will be. In principle, then, a QALY measure, based on a cardinal scale, could be applied to all medical interventions, in order to value them all on a single basis. This would permit value for money comparisons throughout a health service, on the basis that resources could be re-allocated from high incremental cost per QALY procedures to those with low incremental cost per QALY.
