Cost-per-QALY league tables: their role in pharmacoeconomic analysis.

It has become common for analysts to present the findings of cost-utility analyses in cost per quality-adjusted life-year (QALY) league tables or rankings. These purport to show the relative value-for-money of different healthcare technologies. Concomitantly, there is an increasing market for cost-effectiveness data worldwide. However, the practice of constructing league tables has drawn criticism. Claims of inappropriate comparisons, and poor and flawed methodology have been made. How should decision-makers view cost/QALY league tables? In future, published league tables will need to be more informative and thus, by necessity, complex. The principal obstacle to informing health policy-makers with economic analysis is the lack of appropriate outcome data. From this follows uncertainty as to what represents acceptable value-for-money in healthcare purchasing. Thus, the long term objective must be to obtain valid assessments of the value of current and new health service activities. It is in this context that league tables may eventually be most helpful. More immediately, a strategy is required to help decision-makers to prioritise resources rationally with incomplete information.