Healthy-years equivalent: Wounded but not yet dead

Abstract

The quality-adjusted life-year (QALY) has become the dominant measure of health value in health technology assessment in recent decades despite some well-known and fundamental flaws in the preference-elicitation methods used to construct health-state utility weights and the strong assumptions required to construct QALYs as a measure of health value using these utility weights. The healthy-years equivalent (HYE) was proposed as an alternative measure of health value that was purported to overcome many of the limitations of the QALY. The primary argument against the HYE is that it is difficult to estimate and, therefore, impractical. After much debate in the literature, the QALY appears to have won the battle; however, the HYE is not yet dead. Empirical research and recent advances in methods continue to offer evidence of the feasibility using the HYE as a measure of health value and also addresses some of criticisms surrounding the preference-elicitation methods used to estimate the HYE. This article provides a brief review of empirical applications of the HYE and identifies recent advances in empirical estimation that may breathe new life into a valiant, but wounded, measure