ABSTRACT
Drawing on the assumption that the objective of the National Health Service (NHS) is to maximise health, it is frequently argued that priority setting should focus on maximising health gain. Indeed, many commentators treat maximising health gain as being synonymous with healthcare rationing. Some criticisms of quality-adjusted life year (QALY), and similar health status measures, relate to methodological problems in their construction and calibration, including how different levels and dimensions of quality of life are measured, how different health states are valued, how values are elicited, whose values should be used and what the resulting values mean. These are all very important issues for priority setting. QALYs are also criticised for what their advocates claim is their main strength – the combining of quality of life with length of life and the resulting direct comparison (trade-off) of life-saving treatments with quality-enhancing treatments.
