A bill to ban metrics used to evaluate medical interventions is advancing in the U.S. House of Representatives.
The Protecting Health Care for All Patients Act (H.R. 485) introduced by Chair Cathy McMorris Rodgers (R-WA) was approved by the House Energy and Commerce Committee on a vote of 27 to 20 on March 24. The bill would prohibit Medicare, Medicaid, and other federal health programs from using Quality Adjusted Life Years (QALYs) and similar measurements in coverage and payment determinations.
The QALYs metric “… is used to discriminate against people with chronic illnesses and disabilities, like cystic fibrosis, ALS, or Down’s syndrome, putting them at the back of the line for treatment,” McMorris said, in a press release.
‘Risks Life-enhancing Advances’
Sens. Ron Johnson (R-WS), Mike Crapo (R-ID), and other Republican members of the Senate Finance Committee stated concerns like Rodgers’ in a letter to Health and Human Services (HHS) Secretary Xavier Becerra and Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure on March 1.
“While recent decades have seen countless life-saving and life-enhancing advances in treatments and cures for conditions affecting vulnerable communities and seniors, the rise in QALYs risks reversing these trends, particularly as the government bureaucracy plays an increasing role in cost-effectiveness analyses for new medications under the partisan Inflation Reduction Act (IRA),” the Senators wrote.
Eliminating QALY metrics in determining the value of a drug would ensure the United States continues to be a global leader in biomedical research and development while preventing “bureaucratic price controls from constraining patient access to new treatments, …” the letter states.
Assigning Value to Life
The cost-effectiveness of a medical intervention depends on the value placed on the lives saved, says Linda Gorman, director of health care policy at The Independence Institute.
“In the 1990s, the average from ‘willingness to pay’ studies put the value of a life year at a median of $265,345, more than enough to make screening mammograms cost-effective,” said Gorman. “But a National Institutes of Health [NIH] panel recommended against screening mammography for women aged 40 to 49 years, while conventional government estimates of the value of a life year by various federal agencies ranged from $21,000-$50,000. This decision ignored other estimates from surveys and panel studies with significantly higher values for a life year.”
New cost-effectiveness calculations will be different from judgments made in the past, says Gorman.
“The value attached to various kinds of treatments will vary radically when a system changes from traditional assessments of value developed when medical pricing operated with much less government intervention to the assessments provided when academics and bureaucrats make them,” said Gorman.
‘Inhumane Way to Make Decisions’
After decades of government intervention in the health insurance market, it is important to consider how QALYs can be misused, says Gorman.
“Measures [like QALYs] are only necessary when individuals no longer purchase and pay for their own medical care,” said Gorman. “When people are paying for themselves, they determine what is worthwhile and what isn’t by the amount of money they spend on medical care and how they want to finance it.”
In an analysis published in 2009, Gorman reviewed a reordering of health care priorities by the state of Oregon based on metrics. Many life-saving surgeries were deprioritized in favor of elective surgeries.
Metrics undervalue the lives of the elderly, the disabled, and patients with chronic diseases, Sally Pipes, president of the Pacific Research Institute, wrote in Forbes on April 10.
“QALYs are a pseudoscientific and inhumane way to make decisions about medical treatment,” wrote Pipes. “In countries where regulators rely on these metrics to determine patient access to drugs, they almost exclusively lead to the denial of life-saving treatments.”
‘Essential in Cost-benefit Analysis’
QALYs can make sense in pricing drugs, especially when taxpayers are footing the bill, says John Goodman, president of the Goodman Institute for Public Policy Research and co-publisher of Health Care News.
“Quality adjusted life years are used by all federal regulatory agencies,” said Goodman. “They are essential in cost-benefit analysis, which is how we stop bad regulations.”
The metric is used in medicine to determine the value of drugs, not patients, says Goodman.
“QALYs are never used to determine how much a particular individual’s life is worth,” said Goodman. “They are used to establish rules that everyone lives under and health insurance coverage should be no exception.”
Ashley Bateman (bateman.ae@googlemail.com) writes from Virginia.
