QALYs: The Math Doesn’t Work

Abstract

The quality-adjusted life-year (QALY) is a metric widely used when assessing the cost-effectiveness of drugs and other health interventions. The assessments are used in the development of recommendations for pricing, formulary placement decisions, and health policy decisions. A new bill, H.R. 485, the Protecting Health Care for All Patients Act of 2023, was approved by the US House Energy and Commerce Health Subcommittee that will, if passed, end the practice of using QALYs in all federal programs.1,2 Proponents of the ban say that QALYs undervalue the positive effects of therapeutics on people with disabilities.3 We share their concerns. Furthermore, our review of the mathematical properties of QALYs, including an analysis of quality-of-life utility (QOL utility) data recently collected from patients with inflammatory bowel disease (IBD), has led us to conclude that QALYs are an inappropriate metric of drug and treatment cost-effectiveness for all people, both disabled and nondisabled, and should not be the basis for US healthcare policy decisions.