ISSUE: The quality-adjusted life year (QALY) is a commonly referenced measure of the health effects of medical interventions, but it remains a source of intense controversy. In the US, this controversy has intensified with the recent announcement that CVS Caremark would allow coverage decisions based on cost per QALY, drawing on reports by the Institute for Clinical and Economic Review. As a fundamental component of cost-utility analysis, the QALY allows decision-makers to compare health interventions’ impacts on both the quality and length of patients’ lives using a single metric. However, critics argue that the QALY suffers from serious flaws, including: systematic undervaluation of the health of elderly and disabled populations; failure to capture heterogeneity across and within patient populations; and exclusion of important social factors like impacts on caregivers. In the US, increasing consideration of CEA in decision making has amplified debates over the use of QALYs, but few clear solutions satisfy both its supporters and critics.

OVERVIEW: The QALY has long been a source of controversy among academics, patients, and industry and policy stakeholders. With valid arguments on both sides of the debate, is there a middle ground, and how can it be reached under intensifying budget pressure? Can concerns about the QALY be addressed to the satisfaction of all? Jennifer Bright will moderate and provide context on the ongoing debate and recent developments in the US. Lou Garrison will provide background on the use of QALYs in CEA and value assessment and outline the arguments in favor of the QALY. Eleanor Perfetto will describe the criticisms of the QALY and represent the perspective of concerned patients. Anna Kaltenboeck will provide perspective on the practical challenges confronting value assessors and opportunities to learn from other countries. Panelists will provide brief presentations, with 30 minutes reserved for panel discussion and audience questions.