Is a QALY still a QALY at the end of life?

Jeff Round*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

38 Citations (Scopus)


Recent research into end of life and palliative care has focused on the development of a replacement for the quality adjusted life year (QALY) as an outcome measure. Reasons given range from the lack of anticipated survival benefit from treatment to the inappropriateness of death as an anchor for valuing health states, or the increased value of time to the individual at the end of life. The Palliative Care Yardstick, has been proposed as an alternative. In this paper, I argue that the QALY should not be abandoned as an outcome measure in end of life and palliative care populations and suggest possible methods for generating empirical data to support or refute this. I show why the arguments made for replacement of the QALY are not supported by current evidence and how in some cases the abandonment of the QALY framework would lead to an unjustifiable inequitable distribution of resources.

Original languageEnglish
Pages (from-to)521-527
Number of pages7
JournalJournal of Health Economics
Issue number3
Publication statusPublished - May 2012


  • End of life care
  • Ethics
  • Palliative care
  • Quality of life
  • Resource allocation


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