Abstract

Concerns about quality-adjusted life years (QALYs) being discriminatory have reached a fever pitch in the United States, culminating in the US House of Representatives passing the Protecting Health Care for All Patients Act of 2023 (HR-485).¹ Based on these concerns, the bill would ban use of the QALY “and other similar measures” in decision making for federally funded healthcare programs—most notably Medicare and Medicaid, which together cover more than 146 million beneficiaries.^2,3

Discrimination concerns have come from patient organizations and other groups, who contend that the QALY is biased  against older adults and persons with disabilities.We provide an updated viewpoint on these concerns in the context of evolving science and the recent legislative efforts, adding to other voices on the matter.^4-6 We emphasize that the QALY can provide useful information for decision making, with appropriate use it will not be discriminatory, and that it should be available for use in combination with other summary measures of health benefit. We recognize that the debate is taking place in a complex political landscape, but such political considerations are beyond the scope of this commentary.