QALYsB

QALYsB, short for Quality-Adjusted Life Years with Burden, is a theoretical extension of the standard Quality-Adjusted Life Year used in health economics. It seeks to incorporate broader societal impacts of health states, including caregiver strain, productivity losses, and out-of-pocket costs, in addition to patient health-related quality of life.

Calculation typically combines a conventional QALY component with a Burden index. The QALY component uses established health-state utilities (e.g., from EQ-5D or SF-6D). The Burden index aggregates metrics of caregiver burden, financial costs, and social service use, normalized to a common scale, and integrated with the QALY component through an additive or multiplicative model.

Applications and implications: QALYsB is intended for use in health technology assessment and priority setting to reflect wider social value. It is designed to be compatible with existing cost-effectiveness frameworks, but it also prompts consideration of equity, distribution, and data needs beyond patient outcomes. It remains primarily a research concept rather than a standard policy metric.

Limitations and criticisms: Some observers raise concerns about double counting, the difficulty of measuring caregiver and societal burdens consistently, and ethical questions about valuing non-patient outcomes equally with patient health. Cross-country comparability can be hindered by divergent social-support structures, and data availability for Burden components is often limited.

Status and outlook: As a proposed metric, QALYsB has yet to achieve broad policy adoption. Proponents argue it could enrich HTA, while critics caution against expanding value judgments beyond patient-centered outcomes. Ongoing methodological work continues to test validity, reliability, and practical implementation.