Although recommendations are based on international evidence, diagnostic and therapeutic decision-making process is customized and based on cost-effectiveness. This approach allows the quality of care to be measured using a simple criterion called ONCO/QALY.

ONCO/QALY is a new concept that consists of practicing oncology (ONCO) based on the benefit produced by medical interventions (QALY).

QALY stands for quality-adjusted life year. It contemplates both the time of life gained and the quality of life achieved with any specific recommendation. QALY is obtained by multiplying the estimated life span (in years) by the quality of life, represented in fractions of 1 (100% quality of life).

The figure shows QALY obtained without the intervention (brown sphere) and with a hypothetical positive intervention (blue sphere). Without the intervention, the patient lives 20 years, but with a 50% quality of life (0.5). The product (20 x 0.5) corresponds to a QALY = 10. With the hypothetical positive intervention used in the illustration, the patient increases the life span to 30 years and improves the quality of life, reaching 80% (0.8). The product (30 x 0.8) corresponds to a QALY = 24.

The use of QALY to guide treatment decisions points to a measurement-based care model, better qualifying shared decision-making.