title: Is the aim of the English health care system to maximize QALYs?
abstract: OBJECTIVE
  To compare the types of benefit considered relevant by the English Department of Health with those included by the National Institute for Health and Clinical Excellence (NICE) when conducting economic evaluations of options for spending limited health care resources.
  
  
  METHODS
  We analysed all policy Impact Assessments (IAs) carried out by the Department of Health (DH) in 2008 and 2009. The stated benefits of each policy were extracted and thematic analysis was used to categorise these.
  
  
  RESULTS
  51 Impact Assessments were analysed, eight of which mentioned quality-adjusted life year (QALY) gains as a benefit. 18 benefits other than QALY gains were identified. Apart from improving health outcomes, commonly referred to benefits included: reducing costs, improving quality of care, and enhancing patient experience. Many of the policies reviewed were implemented on the basis of benefits unrelated to health outcome. The methods being used to apply a monetary valuation to QALY gains (in cost-benefit calculations) are not consistent across Impact Assessments or with NICE's stated threshold range.
  
  
  CONCLUSIONS
  The Department of Health and NICE approach resource allocation decisions in different ways, based upon overlapping but not congruent considerations and underlying principles. Given that all these decisions affect the allocation of the same fixed health care budget, there is a case for establishing a uniform framework for option appraisal and priority setting so as to avoid allocative inefficiency. The same applies to any other national health care system.
authors: Office of Health Economics, London, UK. kshah@ohe.org
authors: Koonal
authors: K
authors: Shah
authors: Cecile
authors: C
authors: Praet
authors: Nancy
authors: N
authors: Devlin
authors: Jonathan
authors: J
authors: Sussex
authors: John
authors: J
authors: Appleby
authors: David
authors: D
authors: Parkin
mesh_terms: D003362:Cost-Benefit Analysis; D004739:England; D006077:Government Agencies / Q000191:economics / Q000458:organization & administration*; D015276:Health Care Rationing / Q000191:economics*; D006291:Health Policy; D006801:Humans; D009937:Organizational Objectives; D019057:Quality-Adjusted Life Years; D013222:State Medicine / Q000191:economics / Q000458:organization & administration*