Students preparing for medical school interviews should have a good grasp of various hot topics that can be applied to their answers. QALYs are a very important tool in the NHS and therefore are an important topic to be informed on.
This article looks at what QALYs are, how they are used and calculated, some limitations, ethical considerations, and how to answer questions on them in interviews.
Combine your reading here of medicine interview questions and model answers with medicine interview tutoring or 1-1 mock interviews to ensure even greater success in your interviews.
QALYs: A Summary
A QALY is a Quality-Adjusted Life Year.
QALY = time spent in a particular health state x Health-Related Quality-of-Life score
QALYs are used in the calculation of the cost-effectiveness of treatments.
There are several limitations of QALYs which you must learn about.
You need to understand what QALYs are, how they are used, and some ethical considerations for your medicine interviews.
👉🏻 Read more: Ultimate Medicine Interview Preparation Guide
What are QALYs? What is the definition of a QALY?
QALY Meaning
QALY stands for ‘Quality-Adjusted Life Year’.
1 QALY = one year of life in perfect health.
QALYs are used in the assessment of treatments for certain conditions.
How are QALYs calculated? The QALY Calculation:
The QALY Formula: QALYs are calculated by multiplying the time spent in a particular health state by the HRQL score.
QALY = time spent in a particular health state x Health-Related Quality-of-Life score
What is the HRQL score?
The HRQL score is the Health-Related Quality-of-Life score. It is a subjective score which looks at how a patient views their health and quality of life.
There are a few different ways to calculate the HRQL score, however, you would not be expected to know this for an interview.
The HRQL score incorporates things such as a person’s mobility, pain, anxiety etc.
👉🏻 Read more: NHS Core Values
How are QALYs used?
QALYs are used in the assessment of medical treatments by the National Institute for Clinical Excellence (NICE). NICE is the body that provides national guidance on health and social care in the UK.
QALYs can be used alongside the cost of treatment so that NICE can conclude whether a new treatment should be approved for a condition. It will determine the cost per QALY gained for any new treatments to decide whether it is cost-effective to approve it.
Although not always the case, NICE usually considers treatments which cost less than £20,000 per QALY gained as cost-effective. However, some treatments under £30,000 per QALY gained can be considered cost-effective depending on how they affect the quality of life of patients.
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QALYs and Resource Allocation
The concept of Quality-Adjusted Life Years (QALYs) plays a significant role in the allocation of healthcare resources.
QALYs provide a standardised measure that combines both the quality and the quantity of life to evaluate the value of different health interventions. This methodology allows health economists and policymakers to prioritize resources, aiming for maximum health benefits per unit of expenditure.
For example, if two treatments cost the same, but one yields more QALYs, resources would be allocated to that treatment.
However, the use of QALYs in resource allocation also raises ethical questions. It implicitly values younger or healthier individuals higher, as they can potentially gain more QALYs from an intervention.
Moreover, treatments for rare diseases often have high costs per QALY, leading to dilemmas in their funding. Despite these concerns, QALYs remain a crucial tool for objective comparisons in healthcare resource allocation.
Example scenario on QALYs
An example scenario is included here to aid your understanding of QALYs. However, you don’t need to know how to do this for your medicine interviews.
The QALY Calculation
A patient is suffering from a chronic health condition and takes medication A. On this current treatment, the patient is expected to live for 10 years.
However, this condition affects the patient’s quality of life and has reduced it to 60% of what someone in full health would experience.
Therefore, medication A gives the patient 10 x 0.6 = 6 QALYs. In other words, the patient receives the equivalent of 6 years in perfect health from the medication he is currently on for his condition.
A new treatment - medication B - becomes available for the patient’s condition which minimises their symptoms almost entirely. Their quality of life would increase to 90% of what someone in full health would experience. Therefore, medication B would give the patient 10 x 0.9 = 9 QALYs.
The new treatment would give the patient a net gain of 3 QALYs.
Cost-effectiveness using QALYs (ICERs)
As demonstrated above, medication B gives patients an extra 3 QALYs.
This can be used to calculate how cost-effective the new medication is.
Medication B costs £33,000 more than medication A.
Therefore, 33,000/3 = £11,000 per QALY. This is the Incremental Cost-Effectiveness Ratio (ICER).
Medication B would therefore likely be deemed cost-effective.
However, it is important to be aware that QALYs are not the only parameter used in cost-effectiveness calculation.
👉🏻 Read more: Common NHS Hot Topics
Limitations of QALYs
It is important that you learn the limitations of using QALYs to help answer questions in your medicine interviews.
Quality of Life is hard to quantify. Many patients will value things like mobility differently from others and thus it is difficult to standardise any scales on quality of life.
There are issues with the way QALYs are calculated. In terms of QALYs, 6 months of perfect health is the same as 1 year experiencing a quality of life reduced by 50% (as both calculations would equal 0.5). It is unlikely that many patients would see these two scenarios as equal.
QALYs view all people as the same. It does not take into account the characteristics of patient groups. Therefore, QALYs will not help with existing health inequities that affect certain patient groups, as the characteristics of the group would not be identified in the QALY calculation.
A valid “cost-effective” threshold is very difficult to establish, especially as some treatments may have positive effects on patients that cannot be grasped by the QALY calculation.
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Effect of QALYs on patient care
QALYs are used to give patients access to new treatments for their conditions, which is a positive for patients.
However, QALY calculations can also restrict new treatments. A drug may positively impact a patient group’s quality of life, but if it is too expensive, it may not be approved by NICE. This means that patients would not be able to get this treatment on the NHS.
An example of how patient groups can be negatively impacted by QALYs and cost-effectiveness calculations is NICE’s refusal to approve Orkambi for the treatment of cystic fibrosis.
Orkambi was found to greatly increase the quality of life of those suffering from cystic fibrosis. Although it is now available on the NHS for select patients, NICE has refused to approve the drug, due to it not being cost-effective. The ICER for Orkambi was between £218,000 and £349,000 per QALY.
👉🏻 Read more: 7-Day NHS
Ethical Considerations of QALYs
It is important to understand the ethical considerations of QALYs and be able to discuss these in your medical interviews.
Autonomy: The use of QALYs in the assessment of treatment options for conditions does restrict the autonomy of patients, as some treatments can be refused because of their ICER.
Non-maleficence/beneficence: Whilst QALY/ICER calculations can approve drugs for patients and thus improve their quality of life, these measurements also lead to drugs getting restricted that would otherwise positively affect patients.
Justice: It can be argued that patients are not viewed fairly by the QALY measurement, as it assumes that a life of better quality is of more value.
👉🏻 Read more: Answering Medical Ethics Questions
Preparing for a Medicine Interview: QALYs
You need to have an understanding of what QALYs are and how they are used. They are great to bring into question topics such as resource allocation and the economic side of the NHS.
You do not need to know every single detail of QALYs for your interviews. Being familiar with what they are, how they are used in simple terms and some ethical considerations will be enough to demonstrate your understanding in interviews. It might be good to reference in questions on organ donations, or questions on ‘who would you give this liver to’ etc.
👉🏻 Read more: Medicine Interview Topics
Medicine Interview Questions on QALYs
What are QALYs?
How are QALYs used in healthcare?
What are some advantages of using QALYs in healthcare?
What are some concerns or limitations of using QALYs in healthcare?
How does the concept of QALYs support the ethical principle of distributive justice within the healthcare sector? Are there any limitations to this?
In your opinion, how well does the use of QALYs align with the core values of the NHS, such as comprehensive service provision and responsiveness to individuals' health needs?
What are some of the ethical concerns surrounding the use of QALYs in healthcare?
How can QALYs affect patients and their care?
Can you discuss a scenario in which QALYs might not be an effective measure for determining the worth of a healthcare intervention, and suggest potential alternatives?
Why is cost-effectiveness important for the NHS?
How does the QALY model weigh the benefits of treatments for chronic conditions versus acute conditions? Could this have any implications for health equity?
What do you think of QALYs and how they are used in healthcare? Do you think there should be an alternative measure?
How might the quality of life be hard to quantify?
How might a treatment benefit a patient in ways that aren’t included in quality-of-life calculations?
Can you explain what Quality-Adjusted Life Years (QALYs) are and how they contribute to healthcare resource allocation within the NHS?
👉🏻 Read more: 280 Medical School Practice Interview Questions
Top Tips for answering questions on QALYS
The important things to consider when answering questions about QALYs:
Try not to overcomplicate QALYs. Learn what they are in simple terms and practice explaining them simply to other people.
If you’re asked about resource allocation in the NHS, try and incorporate QALYs into this to demonstrate the depth of your knowledge.
You may be asked your opinion on QALYs or how resources are allocated in the NHS. Make sure you are comfortable with the benefits and limitations.
👉🏻 Read more: MMI Medicine Interview Tips Guide
Interview model question and answer: QALYs
Q: What are some advantages of using QALYs in healthcare?
A: QALYs, or quality-adjusted life years, are used to analyse the effect of a new treatment on someone’s quality of life. The scores generated are then used to calculate the cost-effectiveness of the new treatment.
One advantage of using QALYs is that it is a quantitative figure, and therefore they can be compared easily. Furthermore, quantitative data can tell us lots of information within a number, so is more efficient.
Another advantage of using QALYs is that the calculation used to calculate them is simple. Therefore, it makes the calculation of QALYs more accessible and many people can use them.
Lastly, the use of QALYs allows cost-effectiveness to be more patient-centred. Instead of NICE disregarding new treatments because they cost too much, the treatment’s effect on the quality of life is calculated and incorporated into this to conclude cost-effectiveness.
Therefore, there are benefits to the use of QALYs in medicine.
👉🏻 Read more: Medicine Interview questions guide
Frequently Asked Questions
What is a QALY?
A QALY is a Quality-Adjusted Life Year.
How do you calculate QALYs?
QALY = time spent in a particular health state x Health-Related Quality-of-Life score
What is an example of a QALY calculation?
Consider a patient who has a chronic condition and is expected to live for 10 more years. If the patient's quality of life is judged to be 70% of perfect health due to the symptoms of their chronic condition, the QALY for that patient would be calculated as follows: 10 (years of life) x 0.70 (quality of life) = 7 QALYs. In other words, the patient's 10 remaining years are equivalent to 7 years in perfect health.
Why are QALYs important?
QALYs are important because NICE uses them to demonstrate how new treatments affect patients’ quality of life.
What is a criticism of QALYs?
There are some disadvantages to using QALYs to compare treatments:
Doesn't Match Reality: Living for a year at half quality isn't the same as six months at full quality, even though both score as 0.5 QALYs.
Not Fair for Some: Older and disabled people might get lower QALY scores, making their treatments seem less valuable.
Subjective: Quality of life is personal and can vary a lot between people.
Promotes Inequality: People who can gain more QALYs might get more healthcare resources, leaving out others.
Hard to Measure: Figuring out how much quality of life changes due to treatment is a tough task.
What is the advantage of using QALYs?
QALYs are simple to use and calculate.
Easy Comparison: QALYs help compare different health treatments, no matter the illness.
Life Quality and Length: QALYs look at how long and how well a person lives, not just if a treatment works.
Helps with Choices: QALYs help decide which treatments give the most benefit for the cost.
Patient's View: QALYs consider how patients feel about their own health and treatment.
What is the difference between a QALY and a DALY?
QALYs measure how many years are lived with a good quality of life, whereas DALYs (Disability-Adjusted Life Years) measure how many healthy life years have been lost.
A QALY measures the number of years lived in perfect health, taking into account both the quality and the quantity of life lived. The higher the QALY, the better.
In contrast, a DALY is a measure of overall disease burden and is used to quantify the gap between a population's current health status and an ideal situation where everyone lives into old age free of disease and disability. The DALY combines years of life lost due to premature mortality and years of life lived with disability. The lower the DALY, the better.
How do you calculate DALYs and QALYs?
As mentioned above, QALYs are calculated by multiplying the time spent in a particular health state by the Health-Related Quality-of-Life score.
DALYs, on the other hand, are calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for people living with the health condition or its consequences.
For YLL, you would multiply the number of deaths at each age by the standard life expectancy at that age. For YLD, you would multiply the incident cases in that period by the average duration of the case until remission or death (years) and a weight factor that reflects the severity of the disease on a scale from 0 (perfect health) to 1 (dead).
What does cost-effectiveness mean?
In terms of QALYs, cost-effectiveness refers to how much a treatment would cost to yield an increase of 1 QALY in comparison to other treatments already in use.
What is the NICE cost-effectiveness threshold?
NICE has a cost-effectiveness threshold that it uses to approve treatments. Currently, the threshold is less than £20,000-£30,000 per QALY gained.
Can you explain QALYs in simple terms?
In simple terms, QALYs or Quality-Adjusted Life Years is a measure used in healthcare to assess the value of medical treatments. One QALY equates to one year of life in perfect health. If a person's health is less than perfect, the QALY score is less than 1.
For example, if a person's health is considered to be 50% perfect, then one year of life for that person would equal 0.5 QALYs. This system helps healthcare providers decide which treatments provide the most benefit for the cost, especially when resources are limited.
Conclusion
QALYs are an important topic for students to understand and can be a great tool to use in interviews to demonstrate an understanding of how the NHS deals with resource allocation.
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