Presentation (CTI)

OBJECTIVES: The quality-adjusted life-year (QALY) is a leading measure of health in cost-effectiveness analysis. Although the QALY is useful due to its ability to value improvements in health-related quality-of-life (HRQoL), it has faced intellectual scrutiny and legislative challenges due to its potential to unfairly discriminate against disadvantaged patients with lower baseline HRQoL, such as patients with disabilities. However, the currently available alternative measures, life-years (LY), equal value of life years gained (evLYG), and health years total (HYT), all have serious potential issues ranging from logical inconsistencies to unintentional discrimination potential. This paper aims to find a viable equitable measure of health to use in health economic analysis and decision-making.
METHODS: I theoretically analyze the QALY, LY, evLYG, and HYT measures to better understand their limitations, focusing on their effects on patient equity. I analyze the core theoretical drivers of HRQoL-related discrimination arising from health measures as well as axiomatic difficulties that arise when attempting to apply concepts of equity to measures of health.
RESULTS: I develop a novel measure of health which I call the equitable quality-adjusted life-year (EQALY). I also present a novel finding that the evLYG and HYT measures have similar potential to discriminate against disadvantaged patients as the QALY. By contrast, the EQALY measure treats disadvantaged patients equitably, which includes prioritizing low-HRQoL patients while valuing treatments which improve patients’ HRQoL. Additionally, the EQALY allows most existing QALY analysis to be retroactively converted to an EQALY framework.
CONCLUSIONS: The EQALY provides a framework to analyze health outcomes and make treatment reimbursement or funding decisions using while meeting ethical and legal requirements to treat patients with different HRQoL in an equitable manner. It also allows for the conservation of existing health economic analyses through simple retroactive modification using existing estimates.