PURPOSE: The U.S. Affordable Care Act (ACA) prohibits use of Quality-Adjusted Life Year (QALY)-based models that “discount the value of a life of a disabled person.” This Panel will present three methods intended to resolve this problem, discuss their strengths and weaknesses, and then engage in a general discussion (including extensive audience participation) directed towards finding Cost-Effectiveness Analysis (CEA) methods that do not violate the ACA constraints and which could expand the use of CEA around the world.

DESCRIPTION. The Equal Value of Lives (EVL) method values any improvement in Life Expectancy (LE) at a counterfactual Quality of Life (QoL) value of 1, replacing a presumed lower QoL value due to disability. Scholars argue that this approach under-values interventions that both improve LE and QoL. The Healthy Years in Total (HYT) model makes the same adjustment for LE extensions, but employs counterfactual QoL gains to assess an intervention’s full value. In contrast, the Generalized Risk-Adjusted Cost-Effectiveness (GRACE) model does not alter assumed quantities of LE or QoL for disabled individuals, but instead modifies the value assigned to improvements in QoL and LE, using a utility-maximizing model of value that incorporates diminishing returns to QoL. In Europe, WTP thresholds are being adjusted using severity of illness, with the UK set to adopt specified weights as in the Netherlands. Presenters will discuss how these approaches differ, the data needed to implement them, and to what extent they resolve the ACA’s prohibition against using QALY-based methods that discriminate against disabled persons. The panel will then include extensive Q&A audience participation, guided by the Discussion Leader. Any stakeholder who has an interest in understanding how HTA models incorporate permanent disability and/or resolving the Affordable Care Act ban on use of QALYs that discriminate against disabled people should attend.