Value assessment in general, and the use of cost-effectiveness in particular, is receiving renewed interest as a tool for controlling health care spending. Currently, the most common method for determining incremental cost-effectiveness of healthcare interventions is based on a calculation of quality-adjusted-life-years (QALYs). While the model has a basic appeal for making population-level decisions (by reducing patient populations to single, aggregate numeric values), it also poses several significant concerns from the vantage point of patient-centeredness and efforts to preserve access to needed care for individual patients and people with disabilities. Of particular concern to me are the implications of use of QALYs for discrimination against people with disabilities, and its conflicting goals from the goals of personalized medicine.
PIPC is particularly concerned about the implications of healthcare coverage policy built on population-based value assessments on people with disabilities and patients with chronic conditions who may or may not be cured, but regardless are seeking access to treatments and health interventions that improve their quality of life. More specifically, people with disabilities and patients with chronic conditions have a long history opposing the use of quality-adjusted-life-years (QALYs) as the benchmark to measure the value of health care interventions. As applied to real-world policy and decisions about access and coverage, they argue QALY-based metrics often conclude that people with disabilities are not worth it - that their lives are not valuable - and results in denied access to care. Such simplistic average measures of value are perceived to reinforce the old paternalistic system of health care and work against the nation’s efforts to achieve personalized medicine and to develop targeted individualized therapies through the Precision Medicine Initiative.
While not without their place in academic research, QALYs are not the appropriate tool for assessing the value of healthcare interventions for real-world applications and decision-making. This brief provides an overview of the QALY, assesses its suitability as a mechanism to determine health care “value,” and provides information on alternative measures of value.
Alternatively, PIPC aims for policymakers to focus on health care payment and delivery reforms that activate and engage patients and people with disabilities and that support shared decision-making between patients and people with disabilities, and their providers. We believe that solutions that center on delivering care that patients and people with disabilities value are the best approaches to improving overall health care efficiency and quality.
While not without their place in academic research, QALYs are not the appropriate tool for assessing the value of healthcare interventions for real-world applications and decision-making. This brief provides an overview of the QALY, assesses its suitability as a mechanism to determine health care “value,” and provides information on alternative measures of value.
Alternatively, PIPC aims for policymakers to focus on health care payment and delivery reforms that activate and engage patients and people with disabilities and that support shared decision-making between patients and people with disabilities, and their providers. We believe that solutions that center on delivering care that patients and people with disabilities value are the best approaches to improving overall health care efficiency and quality.
| PIPC White Paper - Uses and Misuses of the QALY |
| Executive Summary - Uses and Misuses of the QALY |
