CEVR Faculty and Staff State Opposition to Proposed Massachusetts Legislation Limiting Cost-Effectiveness Analysis

Date: November 11, 2021

The Honorable Senator Cindy F. Friedman & Senate Chair The Honorable Representative John J. Lawn, Jr., House Chair

Massachusetts Joint Committee on Health Care Financing

24 Beacon Street

Boston, MA 02133    



Dear Senator Friedman and Representative Lawn:

We are opposed to advancing both S753/H201 and S745/H1256 out of the Joint Health Care Financing Committee.  We support the legislation’s goal of ensuring fair access to health care technologies and services for all people, regardless of disability.  However, the legislation does not recognize the need to assess value so that Massachusetts can ensure that its citizens pay fair and appropriate prices and that we spend our healthcare dollars wisely.  Moreover, while any analytic tool can be misused, the tools prohibited by this legislation – like the quality adjusted life year (QALY) – do not discriminate against people with disabilities when applied in practice.

Provisions of concern include:

  • H201 and S753, stating that the Massachusetts Division of Medical Assistance and the Massachusetts Health Policy Commission “shall not develop or utilize, directly or indirectly through a contracted entity or other third party, a dollars-per-quality adjusted life year or any similar measure or research in determining whether a particular health care treatment is cost-effective, recommended, the value of a treatment, or in determining coverage, reimbursement, appropriate payment amounts, cost-sharing, or incentive policies or programs.”
  • H1256 and S745, stating that “For any public or private entity, or agency of the commonwealth, when determining whether a healthcare treatment should be available within a formulary, or determining the value of a healthcare treatment, to assume in such a determination that individuals who use or would use that treatment have a reduced quality of life due to a disability or chronic health condition, that their life is less worth saving due to a disability or chronic health condition, or based on any measure, metric, or third party analysis which has the effect of setting a value for the life of a person or persons with a specific disability or medical diagnosis that is less than the value given to the life of a person or persons without a disability.”

We oppose this legislation because the health care system needs a way to measure value.  Spending too much – for example, on a hospital procedure or a medication – takes resources away from other care that might improve health more.  Paying too little can deny patients access to valuable interventions, and discourage our life sciences sector from investing in future innovation.  Analytic tools such as the QALY help to quantify the benefit to the patient, and identify an appropriate price for each treatment.  Having these tools is crucial in health care because unlike most other products and services, parties other than the ultimate consumer – such as clinicians and health insurance companies and programs – have considerable influence over the options.  Objectively quantifying benefits helps to ensure recognition of how treatments benefit patients.  The alternative is to rely on intuition or backdoor negotiations about a drug’s benefits and costs, an approach that is faulty and vulnerable to the undue influence of interest groups.

While well intentioned, the legislation prohibits tools that help, rather than discriminate against people with disabilities.  The QALY’s concept is simple – it places value on what people want – longer life and improved health, meaning better function and reduced pain.  Opponents mischaracterize the QALY’s purpose, saying that because it awards a reduction in disability, it places less value on people with disability, and hence that it discriminates against this population.  The opposite is true.  Placing a lower value on years with disability means that the QALY recognizes the value of treatments that improve quality of life for people with disability and rewards those treatments by quantifying the improvement.  Another way to think about it is to recognize that the purpose of the QALY is not to place a value on people with different health conditions.  Instead, its purpose is to place a value on treatments in recognition of the longer life and reduced disability that they may confer. 

Finally, in practice, QALYs represent only a single input into decisions about health care.  We agree that decision makers should not rely only on an assessment of QALY gains and costs.  But they need access to the best information about costs and benefits, as with many considerations, so that they can make the best decisions about how to allocate our society’s finite health care resources.


Thank you for your consideration.


James Chambers, PhD

Joshua Cohen, PhD

David Kim, PhD

Tara Lavelle, PhD

Paige Lin, PhD

Peter Neumann, ScD

Natalia Olchanski, PhD

Daniel Ollendorf, PhD

Patricia Synnott, MS, MALD


Faculty and Staff at the Center for the Evaluation of Value and Risk in Health

Institute for Clinical Research and Health Policy

Tufts Medical Center

800 Washington Street, Box 63

Boston, MA 02111


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