WASHINGTON, DC – MARCH 23: Rep. Cathy McMorris Rodgers (R-WA), President of House Energy … (+)
How do you measure a year? Your desktop calendar may suggest months or days. The musical “Rent” offered 525,600 minutes and a number of other more creative measures.
Ask a progressive health policy expert, however, and they’ll offer you perhaps the most shocking option of all. For years, progressives have tried to build their policy proposals around “quality-adjusted life years,” or QALYs. This approach ostensibly assigns a dollar amount to a year of human life.
Many Americans find this kind of calculation preposterous. And a substantial portion of Congress does too. Last month, the House Energy and Commerce Committee approved a bill that would ban federal agencies from using QALYs to assess the cost-effectiveness of drugs and treatments.
This is good news for patients. QALYs are a pseudoscientific and inhuman way to make decisions about medical treatment. In countries where regulators rely on these parameters to determine patient access to medicines, they lead almost exclusively to the denial of life-saving treatments. Keeping QALYs out of the United States will save lives.
QALYs are calculated by determining how many extra years of life a treatment will give a patient and what the quality of those years will be. “Quality” in this case is determined by a patient’s ability to perform common activities efficiently and painlessly. In this system, a QALY value of one equals one year of perfect health, while a value of zero equals one death.
No group in the United States has done more to push QALYs on patients than the Institute for Clinical and Economic Research, or ICER. Whenever the Food and Drug Administration approves a new drug, ICER dutifully produces a report on the drug’s “cost-effectiveness”, which it determines using QALYs. According to ICER’s “Value Assessment Framework”, a QALY is worth between $100,000 and $150,000.
This subjective analysis has a number of potential drawbacks. More worryingly, QALYs underestimate the elderly or disabled, or patients with chronic diseases. Because it costs even more to bring these people back to what ICER and others consider a “quality” year of life, most drugs that can improve or alleviate certain conditions – from the disease to Alzheimer’s and cancer to rare diseases – don’t pass the value test.
That’s one of the reasons House Energy and Commerce Committee Chair Cathy McMorris Rodgers, R-Wash., and her cosponsors introduced the Health Care Protection Act in January. health for all patients. The bill would extend Medicare’s limited ban on QALYs to all federal programs, to ensure that no government regulator can use the metrics to determine coverage, which the bill’s cosponsors call “a clear form of discrimination”.
Predictably, QALY supporters rushed to oppose the bill, saying QALYs can actually save lives and help patients with rare or chronic diseases gain access to expensive drugs.
Evidence from countries where government bureaucrats use QALYs and similar measures to shape health coverage would seem to indicate otherwise.
A 2016 study concluded that the single-payer healthcare system in my native Canada maintained a break-even point of approximately $50,000 CAD per QALY. That’s less than $37,000 in US dollars at today’s exchange rate.
The threshold in Britain was just $36,000 per QALY and in Australia just $47,000 per QALY, according to a 2020 study.
These policies have devastating results. In September 2022, the National Institute for Health and Care Excellence – with its Orwellian acronym NICE – ruled that a new prostate cancer drug was too expensive to be covered by the National Health Service of England and the Country of Wales. That same year, the Canadian healthcare system blocked a man battling cancer from accessing a life-saving drug that the government had already approved because it was too expensive.
QALYs are just a metric that officials in government-run health systems use to deny coverage for drugs they deem “too expensive.” And because the government is the only buyer in these countries, when health systems don’t cover a drug, patients don’t have access to it.
The same would happen in the United States if bureaucrats had the ability to use QALYs to inform decisions about coverage for certain therapies. By working to keep these measures out of the United States, Representative McMorris Rodgers and her colleagues are helping to ensure that Americans continue to have access to the best in medical science.