Perspective: The Value of Care and QALY

Does $50,000 per quality-adjusted life year (QALY) hold value in today's age of high-priced specialty drugs? The authors evaluate this yardstick and recommend changes that could aid cost-effectiveness decisions.

For more than two decades, the ratio of $50,000 per quality-adjusted life-year (QALY) gained by using a given health care intervention has played an important if enigmatic role in health policy circles as a benchmark for the value of care. Researchers have summoned this cost-effectiveness ratio in order to champion or denounce particular investments in medical technologies and health programs. Critics, meanwhile, have argued that the ratio is misunderstood and misused.

The fact that the $50,000-per-QALY yardstick has persisted attests to the medical community's need for a value threshold and to the advantages enjoyed by incumbents. It has endured even as the United States has legislated against the explicit use of cost-per-QALY thresholds, and it has held its own even though common sense might dictate that it should be updated to reflect inflation and economic growth. Like the 4-minute mile in running, which has withstood threats to its relevance (the current record is 3:43, and the sport long ago switched championship races to 1500 m, the “metric mile”), $50,000-per-QALY retains its place in the imagination. As the United States debates anew how much to spend on medical care — a question that has been highlighted by high-priced drugs for cancer and hepatitis C — it is useful to reexamine what the ratio means, why it persists, and how it might be applied more reasonably to inform resource-prioritization discussions in today's health care and economic climate.

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Source: New England Journal of Medicine