The inevitability of outcome management: How should QALYs be used?

During the last two or three years, economists in Britain have advocated the use of cost‐effectiveness criteria to determine National Health Service (NHS) allocation decisions and, in particular, they have provided estimates of the costs of achieving particular outcomes from alternative therapies, especially an additional year of life of full quality (or a quality adjusted life year (QALY)) (eg, Maynard (1987), Akehurst and Drummond (1987)). In North America, similar arguments and comparable cost‐QALY estimates are being produced by a variety of researchers using a range of estimation techniques (for a summary see Torrance (1986)).