[QALYS or not QALYS: that is the question?]. / QALYS or not QALYS: that is the question?

The article discusses the proposal of some health economists to use the "cost per QALY (quality-adjusted-life year)" ratio as an universal indicator for economic assessment of medical interventions, in the so-called "cost-utility" analyses. Authors argue that QALYs are not a straightforward application of expected utility theory, which is the standard economic model of individual behaviours toward risk and uncertainty. Indeed, QALYs are compatible with economic utility theory only if individuals' preferences regarding health states satisfy certain very restrictive properties: utility independence between length of life and quality of life, constancy of the proportional trade-off between quality of life and length of life, risk neutrality towards health states, constancy through time of the utility associated with each health state. Aggregation of individual QALYs to obtain an indicator for patient groups at the societal level also raises complex equity problems. Last but not least, from the epistemological point of view, QALYs are based on the hypothesis that health interventions only affect the health of the individual and not any other aspects of his well-being. The authors conclude that the "cost per QALY" approach should be abandoned in order to avoid ambiguities that could impede the development of health economics in the medical field.

Patient condition affects the collection of peripheral blood progenitors after priming with recombinant granulocyte colony-stimulating factor.

A total of 258 aphereses were performed in 79 patients with nonmyeloid malignancies after mobilization of peripheral blood stem cells (PBSC) with recombinant human granulocyte colony-stimulating factor (rhG-CSF). Apheresis products were examined for viable mononuclear cell (VMC), CD34+ cell, and clonogenic cell contents. The number of progenitors in aphereses differs in subgroups of patients with different diagnoses. However, the number of CD34+ or clonogenic cells is dependent on age and amount of chemotherapy delivered to patients before collection rather than on the nature of the disease itself. In addition, the actual dose of rhG-CSF used to mobilize PBSC and the number of VMC in aphereses influenced the clonogenicity of CD34+ cells, although the daily dose of rhG-CSF seems to play little role on the number of clonogenic cells in each individual apheresis product. CD34+ cell and CFU-C (or CFU-GM) numbers are related parameters, and the relation can be described as linear. However, the linear relation varies in different patient groups, and most of the linearity is induced by the highest sets of values. We conclude that mobilization with low doses of rhG-CSF alone is feasible and that the probability of collecting a high number of peripheral blood progenitors is increased in young patients undergoing apheresis early in the course of the disease. Although the relationship between CD34+ cells and CFUs can be described as linear in well-defined situations, its relevance may be limited because it is not a universal finding.