QALY are ideally suited to justify unjustified low prices for effective medical therapies.
Ethical Considerations
The QALY concept has a low value for regulators, because the assumptions made are purely arbitral.
According to the literature, loss of quality of life after myocardial infarctions shows substantial variation.
It is not clear, what is the loss of life quality ex ante and ex post. Ex ante, the willingness to pay to avoid Stroke may justify a value of quality of life loss e.g. of 70%
Besides the numbers of QALY gained, the associated value of a statical life or value of quality of life loss due to indirect costs is not substantiated sufficiently.
In the sheet “More Detailed Calculations” you may produce any result you wish for the value of a drug!
If you extend the treatment period from 5 to 10 or 20 years, results will completely change, therapies become cost-efficient
Conclusions
QALY calculations show that they may be used only as an only rough approximation to the value of medical therapies.
Health care authorities should accept best case scenarios regarding efficacy and encourage very long therapeutich interventions.
Value based calculations for short time periods are not accurate, e.g. 5 years.
Projections should be made for 20 years.
Monetary value of life and value of loss of life qualities have been poorly studied.
Health care economists tend to ration effective therapies due to high costs per QALY. Their models are rarely in favor of medical profession and disfavor effective medical therapies.