I Have a Better QALY Than You: How to Make Sense of Alternatives to the QALY for Research and Policymaking


Moderator: Dan Ollendorf, PhD, Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
Panelists: Melanie D. Whittington, PhD, MS, Tufts Medical Center (CEVR), Boston, MA, USA; Darius Lakdawalla, PhD, School of Pharmacy, USC Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA; Anirban Basu, PhD, MS, The CHOICE Institute, University of Washington, Seattle, WA, USA


The quality-adjusted life year (QALY) has been a global mainstay for summarizing health gains from treatment and consideration of cost-effectiveness. But the QALY has been criticized by the academic community for its multiplicative nature, proportional tradeoffs between quality and length of life, and misalignment with stated preferences. In the policy sphere, critics argue that QALYs penalize those with severe or disabling diseases, and the QALY has been banned from use for decision-making by US government legislation. Researchers and policymakers have developed alternative measures in response, including the equal-value life year (evLY), healthy years in total (HYT), and the generalized, risk-adjusted QALY (GRA-QALY). Developers have published their rationale, postulated and/or summarized the effects of these measures in practice, and critiqued their competitors. To date, however, they have not been together to debate the merits of these measures and discuss how to move cost-effectiveness policy forward.


Dan Ollendorf (moderator) (10 minutes) will set the stage by reviewing the history of anti-QALY sentiment and providing an overview of the current landscape for use of cost-effectiveness in American decision-making. Each panelist (10 minutes each) will discuss the evolution of their measure (Whittington: evLY; Lakdawalla: GRA-QALY; Basu: HYT), the novel or unique properties each possesses, advantages and disadvantages, and examples of postulated and/or actual use. Each panelist will also offer their critique of the other measures. In the remaining 20 minutes, the moderator will lead a debate among the panelists on the merits of these approaches for research, identification of key gaps in each approach as well as possible refinements to the measures, and ways in which policymakers, payers, and others in the US can usefully employ these measures for technology adoption and resource allocation decisions. The panel will conclude with a Q&A session that includes interactive polling to gauge audience preferences.




Economic Evaluation