Valuing health states, using QALYs and admiring the emperor’s new clothes

Abstract: The recommended approaches for valuing health states are unsuitable for some infectious diseases. For health states that are deemed as temporary there appears to be no agreement on the most methodologically robust approach to their valuation. Evidence to support both these assertions is drawn from the literature on economically evaluating interventions for sexually transmitted diseases and a methodological critique of methods used for valuing temporary health states. But these are not the only challenges. The evaluation of many cancer screening programmes rely on model based economic evaluation and present results in terms of cost per QALY but fail to include any disutility weight for the patients who have been over diagnosed and receive unnecessary treatment. Whilst in the economic evaluations of screening and interventions for pregnant women, there is no consensus on whether the quality of life of the mother or the baby should be combined or not.