Should QALYs be programme-specific?

One reason for the development of quality adjusted life years (QALYs) is to facilitate comparison across health care programmes in terms of productivity per unit of expenditure. However, some approaches to QALY measurement have also been developed using 'programme-specific' dimensions of quality of life. Using data, from a longitudinal trial of long-term care for elderly people, it is shown in this paper that an 'across-programme' method of quality of life measurement is less sensitive to changes in elderly people's health states than programme-specific methods more commonly used in the field of evaluating long-term care. It is argued that the same problem is likely to arise in evaluating care for other common chronic conditions like mental handicap, chronic conditions of childhood and terminal cancer. It is concluded that more work should be carried out comparing across-programme and programme-specific measures of quality of life, otherwise it will be difficult to determine whether certain groups in society are being discriminated against in health service resource allocation due to an insensitive across-programme measure of outcome.