OBJECTIVES

: The Equal Value of Life Years Gained (evLYG) metric was developed to address some stakeholders concerns about the Quality-Adjusted Life Year (QALY). The Institute for Clinical and Economic Review (ICER) has incorporated the evLYG metric, which applies an equal utility adjustment for incremental gains in length of life, into its health technology assessment reports. The objective of our study was to compare cost-effectiveness outcomes for the evLYG and QALY metrics in ICER reports.

METHODS

: We reviewed ICER reports from 12/2018 to 10/2020 covering the period since the introduction of evLYG into ICER reports. Reports were included if they were at or beyond the evidence report stage and included evLYG outcomes. We characterized which reports included evLYG and abstracted QALYs, evLYG, cost per QALY and cost per evLYG outcomes. Descriptive statistics were used to report differences in QALY versus evLYG outcomes.

RESULTS

: Twenty ICER reports were identified between December 2018 to October 2020. The number of reports that included evLYG calculations was 9 of 20 reports (45%), 7 of which were completed assessments and 2 of them were ongoing assessments. Two ICER reports assumed evLYG=QALY: Duchenne Muscular Dystrophy, Hemophilia A. Among reports with different evLYG and QALY estimates, the mean difference in incremental effect and health benefit price benchmark at a $150,000 threshold between evLYG and QALYs was 0.145 and $7,620, respectively. Cost per QALY and per evLYG were reported for 43 drugs. Two drugs, L-glutamine [Sickle Cell Disease] and Nadofaragene Firadenovec [Bladder Cancer], had a cost per evLYG outcome below the $150,000 threshold while the cost per QALY was above.

CONCLUSIONS

: The evLYG metric versus the QALY is either neutral or increases incremental effects. However, the difference was rarely sufficient to move the ICER across commonly used thresholds in the U.S.