That is the title of my article out today in The Evidence Base. Here is an excerpt:
The Centers for Medicare and Medicaid Services (CMS) are now setting drug prices under the Medicare Drug Price Negotiation program. Unlike other health technology assessment (HTA) bodies worldwide, however, CMS will not consider quality-adjusted life years (QALYs) when setting drug prices. The reason is rooted in US law: the Inflation Reduction Act prohibits the use of any metric that discriminates against the elderly or disabled. Because QALYs assign lower value to life extensions for people with poorer baseline quality of life (for instance, individuals with disabilities), CMS determined that using cost per QALY analysis would violate this prohibition. Still, CMS has signaled that it will consider health benefit measures that are nondiscriminatory.
The question then becomes: if not QALYs, then what? The National Council on Disability has highlighted several potential alternatives, including equal value of life years (evLY), health years in total (HYT), and generalized risk-adjusted cost-effectiveness (GRACE). Each of these metrics attempts to preserve the benefits of quantifying health gains while sidestepping the perceived discrimination inherent in QALYs. In the article below, we briefly summarize each of these three different metrics and compare them to the more well-known QALY metric.
In the article, we compare the QALY metrics against evLY, HYT, and GRACE and explain each of their merits and limitations. There is even a handy reference table. You can read the whole article here.
