• Defending the beleaguered QALY

    Peter Neumann, in JAMA, defends the beleaguered QALY.

    Above all, critics conflate QALYs with rationing. […] They imply that QALYs represent an absence of clinical judgment and a loss of control, which could shift from physicians and patients to economists or bureaucrats who themselves do not provide care and who have a cost-containment agenda.

    Such arguments suggest deeper ideologies and agendas, not about QALYs as a metric, per se, but about the autonomy of physicians, about whether health is a private or public good, and about the appropriate role of government in health care. The QALY may effectively be a vessel into which stakeholders pour their frustrations about health care, and rejecting the QALY might be a way to register a stance against the health care system. […]

    For all of its shortcomings, the QALY provides a helpful benchmark in considerations of comparative value. Cost-per-QALY ratios have been endorsed by the US Panel on Cost-Effectiveness in Health and Medicine, composed of physicians, health economists, ethicists, and other health policy experts. They have been supported by various government agencies. Medical specialty societies have cited them in support of clinical guidelines. Researchers have published thousands of cost-per-QALY studies in leading medical and health policy journals. The information will continue to inform a host of questions, such as how frequently to screen for cancer, or how to allocate resources among competing public health programs. […]

    [S]hunning the QALY would not alter the unsustainability of the health spending trajectory or the need to confront the cross-disease and crosssector tradeoffs inherent in health choices, but would merely mask them. […] Unavoidably, ways are needed to measure the value of health care delivered, especially to inform market-based approaches. And the QALY, perhaps a bit bruised by recent events, will be waiting in the wings.

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    • I really do not understand these attacks on methods that let us measure the value of health care. We need these kinds of measures to make rational decisions.