Quality-adjusted life years are useful and not discriminatory – STAT

H.Health policy circles have erupted with debates over precarious management tools: indicators similar to quality-adjusted life years (QALYs) that set the value and price of drugs and other health interventions. Rep. Kathy McMorris Rogers (R-Washington) warns that these approaches can be discriminatory, arguing: It is unconscionable for the health care bureaucracy to coldly determine that someone’s life is of little value.

In January, McMorris Rodgers introduced the “Healthcare Protection for All Patients Act” banning government use of QALYs. McMorris Rodgers is right to be concerned about discrimination in healthcare decisions. But the Health Care Protection for All Patients Act, which will soon move to Markup, will help improve the allocation of health care resources at a fair price, with the aim of helping everyone, including those with disabilities. Unfairly targeting critical tools. .

QALY, as the name suggests, measures health in terms of both length and quality of life, including the ability to be free from pain and engage in activities. Researchers and health insurers use QALYs to estimate the benefits of drugs and other interventions, consider their costs, health benefits, and side effects, and evaluate how the intervention compares to alternatives. It helps in determining whether Analysis using QALY can help flag situations where prices may be excessive and prioritize interventions that provide the most health to cost.

For example, an analysis using QALY suggested that treatment for spinal muscular atrophy justifies the multi-million dollar price tag. It is a rare, debilitating and ultimately fatal disease that strikes newborns. their development and function. Other studies using QALY suggested that paxlovid, an antiviral treatment for Covid-19, was worth the price charged because it significantly reduced the risk of hospitalization and death. , a QALY-based analysis suggested that PCSK9 inhibitors (drugs that treat very high cholesterol levels) improved health, but were priced too high given the limitations of their benefits.

McMorris Rodgers and others are concerned that using QALYs could lead health insurers to deny care to people with disabilities.

Quantifying health gains can seem scary and even uncomfortable. However, the use of QALY should not be confused with “rationing” of care. Difficult decisions about how much to pay for care are inevitable. Using QALY simply informs decisions to maximize people’s health on a limited budget. This is because this measure allows us to compare health gains across treatments and diseases.

QALY reward Health care that improves function, reduces pain, and helps people with severe disabilities re-engage in work and other activities. is not.

Perhaps most importantly, analysis using QALYs is just one input in pricing and reimbursement decisions. Researchers and insurers also consider other information, such as the severity of the disease in question, the availability of alternative therapies, and the benefits and risks of treatments that are not easily quantifiable. For example, because of these other considerations, the Institute for Clinical and Economic Review, a non-profit organization that uses QALY to evaluate new treatments, believes that expensive new gene therapies for rare hereditary retinal diseases are “money.” It was suggested that it represents “value for money”. , despite its unfavorable cost-effectiveness, i.e., the high cost per QALY obtained.

Researchers have also responded by developing alternatives to address potential discriminatory concerns about QALY. Alternatives have been developed to this, such as equating generalized years of life to years of good health, placing equal value on years of life expectancy across disease and populations. Her risk-adjusted QALY adjusts estimates for people with poor baseline health. Cost-effectiveness results using these other measures provide yet another useful piece of information for pricing decisions. , continues to encourage consideration of attributes that may not be adequately captured by traditional QALYs, such as reduced fear of contagious diseases.

Why not skip QALYs and similar metrics entirely? It means that diseases cannot be compared “like-for-like”. Without QALY or its cost-effectiveness coverage, health insurers would slash new and expensive treatments based on cost alone, even if the treatment would benefit individuals with a disabled, severe, or life-threatening condition. You may be more likely to restrict access to Analysis using QALY can help insurers better identify opportunities for health improvement interventions. As an example, the Institute for Clinical and Economic Review released the results of an initiative calling on insurance companies to allow “fair access” to cost-effective treatment.

Concerns about QALYs have already banned Medicare from using QALYs in drug price negotiations under the Controlled Inflation Act. The ban limits Medicare’s ability to pursue value-based drug pricing. A complete ban on QALYs by the Health Care Protection Act for All Patients, and similar measures across all federal programs, unfortunately, would mean a further setback.

Joshua Cohen is Associate Director of the Center for Value and Risk Assessment in Health (CEVR) at Tufts Medical Center. Peter Neumann is the director of his CEVR. Daniel Ollendorf is Director of Value Measurement and Global Health Initiatives at CEVR.they are co-authors The Right Price: A Value-Based Prescription for Drug Prices.

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