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Controversy Over Using Quality-Adjusted Life-Years In Cost-Effectiveness Analyses: A Systematic Literature Review.
Leah Z Rand1, Aaron S Kesselheim2
1Leah Z. Rand (lzrand@bwh.harvard.edu) is a postdoctoral fellow in the Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, in Boston, Massachusetts.
Health Affairs (Project Hope)
|September 8, 2021
Summary
Quality-adjusted life-year (QALY) criticisms hinder health technology assessment and value-based pricing in the US. Addressing methods-based and ethical objections is key to controlling drug costs.
Area of Science:
- Health economics
- Health policy
- Pharmacoeconomics
Background:
- US policymakers are considering health technology assessment (HTA) and value-based pricing (VBP) to manage drug costs.
- The quality-adjusted life-year (QALY) is a primary metric in HTA, but faces significant objections.
- These objections impede the adoption of HTA and VBP for drug price negotiation.
Purpose of the Study:
- To review and address the criticisms leveled against the QALY.
- To clarify the nature of methods-based versus ethical criticisms of QALYs.
- To inform the effective use of QALYs in US healthcare policy.
Main Methods:
- Literature review of criticisms against the QALY.
- Categorization of criticisms into methods-based and ethical concerns.
- Analysis of the implications of each criticism type for policy.
Main Results:
- Methods-based criticisms of QALYs require technical solutions and stakeholder engagement.
- Ethical criticisms of QALYs are broader societal value questions, not unique to QALYs.
- Overcoming these criticisms is essential for implementing HTA and VBP.
Conclusions:
- Addressing QALY criticisms is vital for advancing HTA and VBP in the US.
- Differentiating between technical and ethical objections is crucial for policy development.
- Successful integration of QALYs can support efforts to control healthcare spending.
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