Should the government put a price on human life? The new head of the House Energy and Commerce Committee, Rep. Cathy McMorris Rodgers, R-Wash., doesn't think so. She recently introduced legislation alongside several of her colleagues to ban the use of "quality-adjusted life years," or QALYs, in federal healthcare programs.
A QALY purports to measure the value of one additional year of life. A QALY of one is equivalent to one year of life in perfect health. A value of zero is death. Economists sometimes try to evaluate the cost-effectiveness of a particular health intervention by comparing its price with the number of QALYs it can deliver.
That may sound reasonable. But QALYs reduce people to averages. They also systematically devalue people who are disabled, chronically ill, or aged by assuming that one additional year of life for them is worth less than an additional year for a healthy, able-bodied person.
The upshot is that QALYs give government officials pseudo-scientific cover for restricting or denying access to therapies that could improve, enhance, or even save lives.
And thanks to the Inflation Reduction Act, which grants the government the power to place price controls on prescription drugs, the feds now have a strong interest in using QALYs to conclude that medical innovations aren't worth all that much.
Government officials generally aren't transparent about how much they value an additional year of life. One recent study estimates that Canada's single-payer system will deny coverage for a new medicine costing more than around $50,000 Canadian — or around $37,000 U.S. — per QALY, though there have been exceptions.
At the same time, the Canadian government is increasing its embrace of euthanasia. In 2021, more than 10,000 people received "medical assistance in dying." That's equivalent to 3% of the country's deaths. Next month, people whose sole underlying condition is mental illness will be able to elect euthanasia.
A separate study estimated the United Kingdom's cost-per-QALY threshold at around $36,000 U.S., while Australia's system of universal coverage is willing to pay $47,000 per QALY.
QALYs reduce every person and every treatment to a dollar sign. Does your doctor think this treatment might give you an extra year of life? Too bad — government mandarins have determined that it costs more than that extra year of life is worth.
Consider how the United Kingdom's healthcare cost-effectiveness agency — the Orwellian National Institute for Health and Care Excellence, or NICE — has employed QALYs. Last September, it determined that the breakthrough prostate cancer drug Lynparza was "not cost-effective at its current price." As a result, countless patients suffering the disease could have their lives cut short.
NICE made a similar decision in December, when it determined that a state-of-the-art treatment for the rare, incurable disease AL amyloidosis wasn't worth the British government's money.
Not surprisingly, such QALY-based pricing policies have led to enormous international disparities in access to prescription drugs. Consider that, of the 98 new cancer drugs launched between 2011 and 2019, nearly all of them — 96%, in fact — were available in the United States. In the United Kingdom, just 70% were on offer, while Canadian patients had access to fewer than 60%.
And now that the United States government has gotten into the price-setting business thanks to the IRA, there's concern that QALYs will inform drug pricing in this country, too.
That suspicion was only inflamed in December, when Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure didn't rule out the possibility of consulting QALY studies from the non-profit Institute for Clinical and Economic Review when setting drug prices.
All of which helps explain why Rep. McMorris Rodgers and her colleagues are so eager to ban QALYs from federal programs. Their proposal stands little chance of becoming law, as long as President Joe Biden remains in the White House. Nonetheless, the Republican-controlled House can still use its oversight capacities to sound the alarm about QALYs in the months ahead.
Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is "False Premise, False Promise: The Disastrous Reality of Medicare for All," (Encounter Books 2020). Follow her on Twitter @sallypipes. Read Sally Pipes' Reports — More Here.
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