Know Your Jargon: QALY or quality-adjusted life year

Know Your Jargon: QALY

QALY – Quality-Adjusted Life Year

Maybe you’ve seen the term used in insurance paperwork or the fine print of a medical plan. What does it mean — and how does it impact patients access to care?

As part of our ongoing effort to better educate patients, we present this week’s “Know Your Jargon” entry: QALY. That’s quality-adjusted life year.

Our friend and Patients First blogger, Dr. Rafael Fonseca, explains, “QALY is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value for money of medical interventions.”

We share the term because it’s often used in evaluating treatment decisions, and maybe it shouldn’t.

Drawing upon an article published in 1987 in the Journal of Medical Ethics, Dr. Fonseca questions whether the concept violates the fundamental principles of medical ethics that call for “treating everyone as equal and valuing each life as equally valuable.”

“Because of the focus on life years and not the person a logical arithmetical argument is that QALYs should be allocated to promote fertility and impeded birth control, contraception, etc.,” he argues. “If QALYs are to be used to withhold treatments then they can be used in selecting treating the younger at the expense of the older.”

Flawed Use of QALYs in Value Frameworks

Patients Rising supports a systematic evaluation of the QALY and its appropriateness as a measure in determining value for patients.

Furthermore, we recommend that value frameworks, such as those proposed by the Institute for Clinical and Economic Review, not use misleading terminology such as “gold standard” when referring to the QALY, given its documented flaws and biases as well as the ongoing debate within health economics and policy circles regarding its appropriate use.

Patients Rising recommends an evidence-based, patient-centered approach to defining value that is based in science and eschews the possibility of ideological bias.

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