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The quality-adjusted life-year (QALY) combines the expected effects on longevity and the expected effects on quality-of-life into a single standard measure. QALYs are often used as part of cost effectiveness analysis, particularly when analyzing the effectiveness of drugs.

QALY as a measurement has received a lot of criticism. It's been criticized in concept or in the specifics of how it's defined or used. This criticism often forms the basis for opposition to price negotiations or any limitations on access to a particular drug.

This kind of criticism can make it difficult to reach a consensus on processes that might yield negotiated or regulated drug prices.

Leah Rand, a postdoctoral fellow at Harvard Medical School and Brigham and Women’s Hospital, joins A Health Podyssey to talk about QALY, its criticism, and how to respond to that criticism.

Rand and coauthor Aaron Kesselheim published in the September 2021 issue of Health Affairs a systematic literature review of critiques of QALYs and their relevance to drug health technology assessments.

They identify three main categories of ethical and practical critiques of QALYS, including methodological concerns, criticisms of neutrality, and potential discrimination.

Rand and Kesselheim conclude that understanding and addressing criticism of the QALY is essential for the move to value-based pricing.

Listen as Health Affairs Editor-in-Chief Alan Weil interviews Leah Rand on the pros and cons of the Quality Adjusted Life Year measurement in health policy.

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