The death of QALYs is greatly exaggerated
Peter J. Neumann
The QALY has taken a licking but keeps on ticking.
The US Congress has prohibited its use in some circumstances, including Medicare’s drug price negotiations. Many have criticized the metric on various grounds.
But new data from the Tufts Cost-Effectiveness Analysis (CEA) Registry shows that the number of English-language, published cost/QALY articles continues to rise, reaching 1300 new studies in 2023 (Figure 1). The studies span a wide range of treatments and diseases.
The number of US-based published cost/QALY articles dipped slightly in 2023 but still comprised almost 300 new studies (Figure 2).
As my colleagues and I and many others have long written, like any summary measure, the QALY is not perfect. It perseveres because it offers a useful summary metric that combines mortality and morbidity into a single unit and thus offers a powerful construct for comparisons across diverse interventions and diseases. Importantly, it is a measure of the health gains from treatments, not a measure of the value of people. The cost/QALY ratio can help inform drug price discussions and a host of resource allocation decisions. Decision makers should use it as one input alongside other data. Efforts to improve its measurement should continue.
For more information, visit the CEA Registry.