As healthcare systems strive to allocate resources efficiently, the use of economic evaluation metrics like Quality-Adjusted Life Years (QALYs) has become increasingly important.
As healthcare systems outside of the US strive to allocate resources efficiently, the use of economic evaluation metrics like Quality-Adjusted Life Years (QALYs) has become increasingly common. QALYs are used by decision-makers to assess the value of medical interventions by combining both the quality and quantity of life gained. But how consistently are QALYs used across countries to inform reimbursement and pricing decisions?
To answer this, we conducted a review of Health Technology Assessment (HTA) practices across OECD countries, focusing on the formal and informal use of QALYs in reimbursement and pricing (P&R) decisions. Our findings offer a current snapshot of international trends and highlight how practices have evolved since previous studies.
We found that almost 90% of OECD countries (33/38) use QALYs in some form. 68% of OECD countries (26/38) formally incorporate QALYs into their reimbursement and pricing decisions while 18% (7/38) use QALYs informally – referencing them in HTA guidelines or academic literature, but without formal integration into P&R decision-making. We classify only five countries as ‘non-users’, as we either found no official documentation or published literature indicating the use of QALYs or its use was explicitly excluded.
Our findings align broadly with those of Torbica et al. (2020) and Barnieh et al. (2014), who categorised OECD countries by their degree of economic evaluation use. However, there are some differences: 8 countries (Denmark, Greece, Latvia, Lithuania, Japan, South Korea, Spain, and Switzerland) were labelled as low users in the 2020 study but are now identified as formal QALY users, reflecting policy changes in those countries post-2020. Conversely, Iceland and Israel were previously considered high users but are categorised as informal users in our analysis.
This analysis is subject to certain limitations. Some sources may not reflect the most recent policy developments. In addition, it can be challenging to verify how QALYs and cost-utility data are applied in real-world reimbursement and pricing decisions, especially when such processes are not fully structured.
A table indicating the OECD countries’ classification and related sources can be downloaded here.