title: Does adjusting for health-related quality of life matter in economic evaluations of cancer-related interventions?
abstract: OBJECTIVE
  We investigated the extent to which adjusting for health-related quality of life (HRQoL) alters incremental cost per life-year gained ratios, and the implications for reimbursement decisions.
  
  
  METHODS
  We identified all cancer-related interventions in the Tufts Medical Center Cost-Effectiveness Analysis Registry in which both a cost/quality-adjusted life-year (QALY) and a cost/life-year ratio were reported in the same study. We assessed the ordinal relationship between these ratios and analyzed the extent to which using a cost/QALY rather than a cost/life-year ratio would potentially yield different reimbursement decisions.
  
  
  RESULTS
  The rank-order correlation between cost/life-year and cost/QALY ratio pairs was 0.917 (p < 0.0001). In 78.8% of comparisons, both cost/QALY and cost/life-year ratios were below a prespecified threshold (e.g., US$50,000 per QALY or life-year). Adjusting for HRQoL resulted in a higher ratio such that it crossed a prespecified threshold in 18.6% of interventions. The data suggest that adjusting life-years for HRQoL does not substantively affect cost per life-year ratios for the vast majority of cancer-related interventions.
  
  
  CONCLUSIONS
  Our analysis implies that the method used for HRQoL adjusting or even HRQoL adjusting at all does not matter for most reimbursement decisions on life-saving interventions. The results could differ for interventions that have large impacts on patients' HRQoL compared with the impact on survival.
authors.affiliation: The Center for the Evaluation of Value and Risk in Health, The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. dangr@bgu.ac.il
authors.forename: Dan
authors.initials: D
authors.lastname: Greenberg
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Neumann
mesh_terms: D000046:Academic Medical Centers; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D003657:Decision Making; D006801:Humans; D009369:Neoplasms / Q000191:economics* / Q000628:therapy; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012042:Registries; D012051:Reimbursement Mechanisms / Q000191:economics*