Editing Cost–utility analysis (section)

=== Criticism of cost–utility analysis ===

There are criticisms of QALY. One involves QALY's lack of usefulness to the healthcare provider in determining the applicability of alternative treatments in the individual patient environment,<ref>{{cite journal|last=Kind|first=P.|author2=Lafata, J. E.|author3=Matuszewski, K.|author4=Raisch, D.|title=The use of QALYs in clinical and patient decision-making: Issues and prospects|journal=Value in Health|date=February 2009|volume=12|issue=S1|pages=S27–S30|doi=10.1111/j.1524-4733.2009.00519.x|pmid=19250128|doi-access=free}}</ref> and the absence of incorporating the patient's [[willingness to pay]] (i.e. [[behavioral economics]]) in decisions to finance new treatments.<ref>[[National Institute for Health and Clinical Excellence]]</ref>   Another criticism involves age; elderly individuals are assumed to have lower QALYs since they do not have as many years to influence the calculation of the measurement; so comparing a health intervention's impact on a teenager's QALYs to an older individual's QALYs may not be considered "fair" since age is such an important factor. Specific health outcomes may also be difficult to quantify, thus making it difficult to compare all factors that may influence an individual's QALY.
Example: Comparing an intervention's impact on the livelihood of a single person to a parent of three; QALYs do not take into account the importance that an individual person may have for others' lives.

In the US, the health care reform law ([[Patient Protection and Affordable Care Act]]) has forbidden the use of QALYs "as a threshold to establish what type of health care is cost effective or recommended. Also, "The Secretary shall not utilize such an adjusted life year (or such a similar measure) as a threshold to determine coverage, reimbursement, or incentive programs under title XVIII".<ref>{{cite journal|last=Neumann|first=PJ|author2=Weinstein MC|title=Legislating against use of cost-effectiveness information.|journal=N Engl J Med|date=October 2010|issue=16|pages=1495–1497|doi=10.1056/NEJMp1007168|pmid=20942664|volume=363}}</ref><ref>{{cite web|title=Public Law 111 – 148 – Patient Protection and Affordable Care Act|url=http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/content-detail.html|accessdate=24 July 2011}}</ref>