QALYs are barely relevant in this discussion. Quality Adjusted Life Years are an attempt to allocate scarce resources in the absence of a pricing mechanism. It is by no means perfect, but thats not the point - it is used at the margins. Do we spend money on this cancer drug that will extend the life of 75 year old prostate cancer patients by 6 months or spend it on heart disease drugs for children giving them 50+ years. Unless you are one of the 75 year olds or children it is a pretty easy question.

But the question we do not ask ourselves is - do you have the means to pay now you are dying of a horribly expensive disease? No-one cares about QALYS here in the UK except when newspaper editors decide to go for a ratings pull