Is a QALY still a QALY at the end of life?

► Health outcomes for patients at the end of life are difficult to measure and value. ► Some argue that the QALY is not an appropriate outcome measure at the end of life. ► The arguments against the QALY lack empirical or theoretical foundation. ► The strengths of the QALY make it suitable for use in end of life care. ► Improved methods for measuring and valuing health states would improve QALY estimation.