title: The use of Quality-Adjusted Life Years in cost-effectiveness analyses in palliative care: Mapping the debate through an integrative review.
abstract: In cost-effectiveness analyses in healthcare, Quality-Adjusted Life Years are often used as outcome measure of effectiveness. However, there is an ongoing debate concerning the appropriateness of its use for decision-making in palliative care.
  
  
  
  To systematically map pros and cons of using the Quality-Adjusted Life Year to inform decisions on resource allocation among palliative care interventions, as brought forward in the debate, and to discuss the Quality-Adjusted Life Year's value for palliative care.
  
  
  
  The integrative review method of Whittemore and Knafl was followed. Theoretical arguments and empirical findings were mapped.
  
  
  
  A literature search was conducted in PubMed, EMBASE, and CINAHL, in which MeSH (Medical Subject Headings) terms were Palliative Care, Cost-Benefit Analysis, Quality of Life, and Quality-Adjusted Life Years.
  
  
  
  Three themes regarding the pros and cons were identified: (1) restrictions in life years gained, (2) conceptualization of quality of life and its measurement, including suggestions to adapt this, and (3) valuation and additivity of time, referring to changing valuation of time. The debate is recognized in empirical studies, but alternatives not yet applied.
  
  
  
  The Quality-Adjusted Life Year might be more valuable for palliative care if specific issues are taken into account. Despite restrictions in life years gained, Quality-Adjusted Life Years can be achieved in palliative care. However, in measuring quality of life, we recommend to-in addition to the EQ-5D- make use of quality of life or capability instruments specifically for palliative care. Also, we suggest exploring the possibility of integrating valuation of time in a non-linear way in the Quality-Adjusted Life Year.
authors.affiliation: 1 IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Wichmann
authors.affiliation: 2 Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Eddy Mm
authors.initials: EM
authors.lastname: Adang
authors.affiliation: 2 Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Peep Fm
authors.initials: PF
authors.lastname: Stalmeier
authors.affiliation: 1 IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Sinta
authors.initials: S
authors.lastname: Kristanti
authors.affiliation: 3 End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
authors.affiliation: 1 IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Myrra Jfj
authors.initials: MJ
authors.lastname: Vernooij-Dassen
authors.affiliation: 4 Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Engels
authors.affiliation: PACE: Palliative Care in Care Homes Across Europe. An EU-funded international research project.
mesh_terms: D003362:Cost-Benefit Analysis / Q000592:standards*; D006801:Humans; D010166:Palliative Care / Q000191:economics*; D019057:Quality-Adjusted Life Years
keywords: Quality-Adjusted Life Year; cost-effectiveness analysis; debate; palliative care