QALYs and justice.

Health Policy, 10 (1988) 259-266 featured an article by Harris which argued that QALYs (quality-adjusted life years) are unjust, and that their use as a tool for distributing scarce health resources cannot be morally defended. Harris' paper is the latest in a series of articles purporting to criticise the concept and application of QALYs. However, most of the criticisms leveled at QALYs so far have been based on: (1) a failure to distinguish between average/marginal health benefits; (2) confusion about the nature of cost-effectiveness evaluation; and (3) theoretical objections which have not been substantiated by empirical evidence to date. An important problem of QALYs is the difficulty of making interpersonal comparisons; however, it is argued that this problem is not unique to QALYs, but is common to other established mechanisms of distributing scarce health resources. The methods and applications of QALYs are still being developed. At this stage in its evaluation, critical discussion on QALYs should be directed towards more practical issues such as the standardisation of measurement techniques and the reliability/sensitivity of the measuring instruments.