“In a world of limited resources X should go to B because the improvement in B’s quality of life over a year is higher than the improvement in A’s qua

QALY puts a normalised value scale on mobility and physical pain, however it fails to include the importance of mental health in the analysis, which distorts the end result of the quality of life. Moreover, the analysis does not take into account the quality of life of people that are affected by, let’s say, a family member becoming paraplegic after treatment. Also, the aggregate can vary, depending on how the survey was taken. Was it a phone survey? If yes, not all implications of the ranking might have been clear to the interviewee. As mentioned in the previous post, people, who do not suffer from any of these described outcomes, are likely to overestimate the negative effect on their quality of life.
All of these flaws can lead to a wrong person getting the treatment. So B should get the treatment only because his QALY over the first year is higher than the one from A? That does not sound fait. What if A is really poor and has been on a waiting list for this treatment for almost a year and patient B is a privately insured patient and has not been on the waiting list at all, but still gets the treatment. That’s when QALY can lead to a wrong decision. It does not take into account the patients’ budget constraint or urgency of treatment. Person B can maybe afford to pay for more than half of the treatment himself, but A has to wait because he does not have the money and his need for treatment is probably more urgent through the long wait.
The QALY is also an average and not an individualised result for the patient. It may not reflect any of the patients qualities, because results vary through the way they have been surveyed (as described above). QALY just seems like a very mathematical way of dealing with issues of personal health, but they probably have to be when resources are scarce.