Economic evaluation of new health care interventions has become a major area of applied economic analysis. The main technique has been cost-effectiveness analysis and an increasingly important measure of effectiveness in health care, which is called the Quality-Adjusted Life Years (QALY). This measure is data-hungry and requires tools for assessing the impact of an intervention on health-related quality of life (HRQL) and a means of valuing that impact.

“This paper provides a useful tool to researchers who are examining the cost-effectiveness of new healthcare technologies.”

This paper presented a new tool for deriving QALYs that utilizes a widely used pre-existing measure of HRQL (SF-36). There are hundreds and indeed thousands of data sets using this measure and so our tool has proven quite popular.

This paper describes a new methodology. It presents a method for converting previously collected data on HRQL into a tool for use in economic evaluation. It also presents a novel methodology which has been applied by others for different measures.

This paper provides a useful tool to researchers who are examining the cost-effectiveness of new healthcare technologies.

I was involved in an international group concerned with the translation and testing of the SF-36 health status questionnaire. As a health economist, I saw the potential this instrument had in economic evaluation. However, I was aware that, in its current form, it was not suitable for use in economic evaluation, because it was too large and complex for the types of valuations methods we use to derive health state values. It required a significant research effort to adapt it for this purpose.

Initially, I received a small Department of Health grant to pilot an approach to doing this, but I soon realized that I needed the input of colleagues, especially in econometrics. It was also difficult, at the time, to obtain public grants for methodology work, so I sought an independent grant from a pharmaceutical company (GlaxoSmithKline plc) to fund the work and then I recruited Professor Jennifer Roberts, who holds a Chair in the Dept. of Economics, and Mark Deverill, who is a health economist at the Institute of Health and Society at Newcastle University, as my co-investigators working in the Sheffield Health Economics Group at that time.

The tool will continue to be used widely in health services and clinical trials research. The methodology we have developed is starting to be applied to other measures, especially those aimed at specific medical conditions. Future research in this area is likely to take two avenues.

One will be to estimate the relationship between measures, known as mapping or cross-walking, in to order to allow comparisons between studies and evidence synthesis, and to also provide a firmer foundation for cost-effectiveness analysis in healthcare. The other will involve more fundamental methodological work on methods and sources of values for estimating QALYs.

The SF-6D has become one of the tools used by agencies around the world which are concerned with making decisions about the use of new technologies in publicly funded healthcare systems in order to promote efficiency.