The House of Representatives last week approved a bill that would ban the use of “quality-adjusted life years,” or QALYs, as well as other measures for determining the purported value of a medical intervention, in all federal health programs. Now the Senate will consider the measure.
QALYs should have no place in federal decision-making about whether to cover a drug or medical procedure. Their primary purpose is to give the government cover for denying access to treatment — especially for seniors and disabled people.
Researchers use QALYs to estimate the number of years a treatment could add to a patient’s life, while also taking the assumed “quality” of those years into account. Quality is typically based on a person’s ability to carry out everyday activities without mental disturbance or pain.
A QALY value of 1 signifies a perfect year of life, while a value of zero signifies death. The Disability Rights Education and Defense Fund points out that some QALY schemes deem a year of additional life for certain people with severe disabilities worth less than zero — and so worse than death. “Unsurprisingly, individuals in such health states frequently disagree with this assessment,” the nonprofit organization wryly points out.
The idea is to weigh a medical intervention’s cost against the number of QALYs it would buy — and to arrive at a conclusion about that intervention’s cost-effectiveness.
The government has a strong incentive to conclude that expensive therapies are not cost-effective and should thus be denied coverage. The QALY gives them a seemingly scientific way of doing so.
But “quality” is in the eye of the beholder. Eighty-five percent of people aged 65 and older suffer from at least one chronic condition. QALYs necessarily deem additional years of life less valuable for the members of this cohort than they do for younger people in good health.
Consequently, a QALY regime could undervalue treatments for diseases such as Alzheimer’s, cancer, and arthritis — which disproportionately afflict older people — and provide justification for denying coverage.
The story is similar for disabled people. People with Down syndrome are more likely than those without to develop Alzheimer’s disease. QALYs could minimize the value of the emerging class of therapies that’s been shown to slow progression of the disease for the members of this vulnerable group.
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It’s no wonder that nearly 4 in 5 voters oppose the government setting drug prices based on QALYs, according to a fall 2021 poll sponsored in part by the think tank I lead, the Pacific Research Institute.
As House Energy and Commerce Committee Chairwoman Cathy McMorris Rodgers (R-WA) said last week, “Every human life has value.” QALYs undermine that fundamental principle. They must not inform federal health policymaking.
Sally C. Pipes is president, CEO, and Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on X, formerly Twitter, @sallypipes.
