Report Finds No Evidence of Consistent Disadvantage in QALY-Based Analyses
Lawrenceville, NJ, USA—September 28, 2026—Value in Health, the official journal of ISPOR—The Professional Society for Health Economics and Outcomes Research, announced today the publication of a study showing no evidence that the use of quality-adjusted life years (QALYs) inherently disadvantages people with disabilities.
The article, “Do Quality-Adjusted-Life-Year-Based Cost-Effectiveness Analyses Discriminate Against Disabled Patients? A Theoretical and Empirical Analysis,” by Yue Ma, PhD, and colleagues, appears in the September 2026 issue of Value in Health.
In 5 theoretical treatment scenarios, QALY-based results varied by the type and magnitude of treatment effects, rather than consistently disadvantaging disabled patients. In 9 of 11 published cost-effectiveness analyses of selected severe chronic conditions, with disease severity used as a proxy for disability, patients with disabilities had greater QALY gains and more favorable incremental cost-effectiveness ratios compared with a nondisabled cohort, researchers reported.
“Patients with disabilities, despite lower baseline utilities, can still achieve substantial improvements, often yielding comparable or even greater QALY gains than those without disabilities,” lead author Ma, a postdoctoral fellow in health economics at McMaster University in Ontario, Canada, and colleagues wrote.
Because it combines gains in length of life and health-related quality of life into a single measure, the QALY is commonly used to assess the benefit of health interventions. But critics have argued that using this approach risks underestimating the meaningful benefit of a treatment in people with disabilities, because lower baseline health-related quality of life scores could translate into smaller QALY gains.
The researchers tested the concern through both theoretical scenarios and an empirical analysis of 11 published cost-effectiveness analysis studies. Their 5 scenarios examined how QALY-based results changed with different types of treatment effects, such as improved health-related quality of life, longer survival, or both.
The lack of a universally accepted definition of disability was a challenge for the study, so researchers used disease severity as a proxy in 3 chronic conditions: severe rheumatoid arthritis, type 2 diabetes with complications (such as cardiovascular conditions or events), and advanced chronic kidney disease.
“Although severity may not capture broader dimensions of disability, severe disease states are consistently associated with lower health-related quality of life (ie, lower health utility) and thus serve as a reasonable pragmatic proxy for disability,” the authors wrote.
Rather than focusing on a single drug or device, the authors used these disease areas to examine whether QALY-based results were less favorable for patient subgroups with lower baseline health-related quality of life.
The authors acknowledged the use of chronic disease severity as a proxy for disability as a limitation of the empirical analysis. That approach, they noted, may not reflect the full range of disability experiences, including intellectual and developmental disabilities, traumatic injuries, cognitive impairment associated with aging, or end-of-life conditions.
“Measuring and valuing health in persons with disabilities raises distinct ethical and methodological challenges. Future research on QALY-based discrimination should examine these issues and develop methods better suited to capturing health outcomes, preferences, and values,” the authors explained.
The study adds new evidence to a broader debate in the United States about the use of QALYs to inform health policy. For example, the Affordable Care Act and the Inflation Reduction Act have restricted the use of QALYs in certain healthcare policy decisions.
“These actions underscore the ongoing controversy surrounding the use of QALYs in health policy decisions,” the authors wrote.
However, the researchers say their findings point toward using QALYs more carefully. They caution that QALY-based cost-effectiveness analyses are meant to guide decisions within a specific clinical and policy context, not to rank the value of health improvements across patient populations.
“Rather than banning QALYs outright, policy makers should consider prioritizing transparency, requiring subgroup reporting and incorporating complementary equity analyses,” the authors advised.
Click to access the full-text article.
To cite this article: Ma Y, Neumann PJ, Vanness DJ, Li H, Xie F. Do quality-adjusted-life-year-based cost-effectiveness analyses discriminate against disabled patients? A theoretical and empirical analysis. Value Health. 2026;29(9):1580-1589. doi:10.1016/j.jval.2026.04.005
Further reading:
The Apparent Discrepancy Between Social Inequality in Disability-Free and Quality-Adjusted Life Expectancy
Quality-Adjusted Life Years, Quality-Adjusted Life-Year-Like Measures, or Neither? The Debate Continues
The Value of the Quality-Adjusted Life Years
Do Quality-Adjusted Life Years Discriminate Against the Elderly? An Empirical Analysis of Published Cost-Effectiveness Analyses
Measuring Value—The QALY Turns 50: What Has It Achieved and What Is Its Future?
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ABOUT VALUE IN HEALTH
Value in Health (ISSN 1098-3015) is an international, indexed journal that publishes original research and health policy articles that advance the field of health economics and outcomes research to help healthcare leaders make evidence-based decisions. The journal’s current impact factor score is 6.0 and its 5-year impact factor score is 5.7. Value in Health is ranked 5th of 124 journals in Health Policy and Services, 12th of 185 journals in Health Care Sciences & Services, and 37th of 617 journals in Economics. Value in Health is a monthly publication that circulates to more than 55,000 readers around the world.
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