The US House of Representatives is considering legislation (HR 485) that would prohibit the use of the quality-adjusted life-year (QALY) and similar measures for coverage and payment determinations under all federal and state health care programs—affecting both Medicare and Medicaid. The QALY is an important outcome measure used by many cost-effectiveness researchers, yet also represents a tool for making comparative effectiveness assessments of interventions that address the health needs of populations.
Language in HR 485 includes restrictions on the use of evidence or information obtained from government or non-government entities that might then use a price that is derived from an “adjusted life year (or such a similar measure) or using averages or other pricing metrics that directly or indirectly take into account such prices.” The concern expressed by some members of Congress is that the QALY systematically discriminates against elderly, disabled, or terminally ill Americans when used to inform resource allocation decisions or price determinations. This concern is further referenced in the initial guidance for the Medicare Drug Price Negotiation Program. We argue that while the QALY is not perfect, valid alternatives exist that address concerns and that will facilitate explicit consideration of both quality and length of life in comparative effectiveness assessments.
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