title: The social value of a QALY: raising the bar or barring the raise?
abstract: BACKGROUND
  Since the inception of the National Institute for Health and Clinical Excellence (NICE) in England, there have been questions about the empirical basis for the cost-per-QALY threshold used by NICE and whether QALYs gained by different beneficiaries of health care should be weighted equally. The Social Value of a QALY (SVQ) project, reported in this paper, was commissioned to address these two questions. The results of SVQ were released during a time of considerable debate about the NICE threshold, and authors with differing perspectives have drawn on the SVQ results to support their cases. As these discussions continue, and given the selective use of results by those involved, it is important, therefore, not only to present a summary overview of SVQ, but also for those who conducted the research to contribute to the debate as to its implications for NICE.
  
  
  CONCLUSIONS
  The issue of the threshold was addressed in two ways: first, by combining, via a set of models, the current UK Value of a Prevented Fatality (used in transport policy) with data on fatality age, life expectancy and age-related quality of life; and, second, via a survey designed to test the feasibility of combining respondents' answers to willingness to pay and health state utility questions to arrive at values of a QALY. Modelling resulted in values of £10,000-£70,000 per QALY. Via survey research, most methods of aggregating the data resulted in values of a QALY of £18,000-£40,000, although others resulted in implausibly high values. An additional survey, addressing the issue of weighting QALYs, used two methods, one indicating that QALYs should not be weighted and the other that greater weight could be given to QALYs gained by some groups.
  
  
  CONCLUSIONS
  Although we conducted only a feasibility study and a modelling exercise, neither present compelling evidence for moving the NICE threshold up or down. Some preliminary evidence would indicate it could be moved up for some types of QALY and down for others. While many members of the public appear to be open to the possibility of using somewhat different QALY weights for different groups of beneficiaries, we do not yet have any secure evidence base for introducing such a system.
authors.affiliation: Yunus Centre for Social Business & Health, Research Institutes, 3rd Floor Buchanan House, Glasgow Caledonian University, Cowcaddens Road Glasgow G4 0BA, UK. cam.donaldson@gcu.ac.uk
authors.forename: Cam
authors.initials: C
authors.lastname: Donaldson
authors.forename: Rachel
authors.initials: R
authors.lastname: Baker
authors.forename: Helen
authors.initials: H
authors.lastname: Mason
authors.forename: Michael
authors.initials: M
authors.lastname: Jones-Lee
authors.forename: Emily
authors.initials: E
authors.lastname: Lancsar
authors.forename: John
authors.initials: J
authors.lastname: Wildman
authors.forename: Ian
authors.initials: I
authors.lastname: Bateman
authors.forename: Graham
authors.initials: G
authors.lastname: Loomes
authors.forename: Angela
authors.initials: A
authors.lastname: Robinson
authors.forename: Robert
authors.initials: R
authors.lastname: Sugden
authors.forename: Jose Luis Pinto
authors.initials: JL
authors.lastname: Prades
authors.forename: Mandy
authors.initials: M
authors.lastname: Ryan
authors.forename: Phil
authors.initials: P
authors.lastname: Shackley
authors.forename: Richard
authors.initials: R
authors.lastname: Smith
mesh_terms: D000367:Age Factors; D005240:Feasibility Studies; D006304:Health Status; D006801:Humans; D019057:Quality-Adjusted Life Years; D012945:Social Values; D013222:State Medicine; D011795:Surveys and Questionnaires; D006113:United Kingdom; D026712:Value of Life