Valuing health outcomes in cost–effectiveness analyses: health years in total vs QALYs

Researchers have generated a novel framework for valuing health outcomes in cost–effectiveness analyses, termed ‘health years in total’ (HYT), which may allow some of the limitations associated with current best health outcomes measures to be overcome.

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Jan 22, 2020

Published in Value in Health, researchers from the University of Washington (WA, USA) describe a novel framework for valuing health outcomes in cost–effectiveness analyses, using ‘health years in total’ (HYT). It is hoped this new measure will allow some of the limitations associated with the current best health outcomes measures, such as the quality-adjusted life year (QALY) and ‘equal value of life’, to be overcome.

QALYs are both highly disputed and important in cost–effectiveness analyses; use of the QALY allows one to quantify and take account of individuals’ life expectancy and health-related quality of life when conducting cost–effectiveness analyses between interventions and across disease areas. However, the QALY can also discriminate against individuals with lower quality-of-life measures, which has sometimes resulted in the exclusion of its use in public healthcare decision making.

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Lead study author Anirban Basu (University of Washington) explained: “We propose a solution that can address this specific distributional issue of QALYs without failing to account for the quality of life impacts during the added years of life…we introduce the framework of [HYT], which separates life expectancy effects from quality of life impacts through the use of an additive, rather than multiplicative, approach. By disentangling life expectancy impacts from quality of life effects, the HYT framework enables patients with lower quality of life to fully benefit from interventions that extend life expectancy.”

The novel HYT measure is the sum of an individual’s life expectancy and modified QALYs; these altered QALY measures are calculated over a time period corresponding to the maximum survival of any given alternative. Further development, application and validation of the HYT measure framework are required for evaluating its potential for truly overcoming the limitations associated with the use of QALYs and other health outcomes measures.


Basu A, Carlson J, Veenstra D. Health years in total: a new health objective function for cost-effectiveness analysis. Value in Health. 23(1); 96–103; (2020);

Go to the profile of Ilana Landau

Ilana Landau

Assistant Editor, Future Science Group

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