Alternatives to the QALY

That is the topic of a Health Affairs Forefront article (Sullivan et al. 2021) out today which is addresses the topic. The issue is particularly relevant as the Inflation Reduction Act (IRA)’s has a de facto ban on QALYs for use in setting a drug’s maximum fair price (MFP). The authors discuss some alternatives:

The equal value of Life Years Gained (evLYG), Healthy Years in Total (HYT) and the Generalized Risk-Adjusted QALY (GRA-QALY) methods are important advances in the fields of population health measurement and cost-effectiveness research. In the National Disability Council’s report on “Alternatives to QALY-Based Cost-Effectiveness Analysis for Determining the Value of Prescription Drugs and Other Health Interventions,” they write that the evLYG, “eliminates the risk of undervaluing life-extension for people with disabilities,” and that, “disability rights advocates have described HYT as a better approach to standard [cost-effectiveness analysis] CEA because it removes the devaluation of life extension of people with disabilities.”

The authors also wisely caution that while QALYs have their limitations, eliminating the possibility for comparative effectiveness or cost effectiveness methods to inform MFP is highly problematic.