The quality-adjusted life-year (QALY) is a health metric some people love to hate. Concerns include that QALYs are not patient focused,1 may be used as rationing tools by health insurers, and may be perceived as dehumanizing. The Affordable Care Act prohibits the Patient-Centered Outcomes Research Institute from using cost-per-QALY benchmarks. The use of QALYs by policy makers to inform coverage and reimbursement decisions is controversial.
However, QALYs are simply a metric to quantify health. Despite concerns, QALYs endure because they help address a difficult and unavoidable question: how to estimate and compare the benefits of what are often heterogeneous health interventions. Recently, QALYs have received increased interest in the United States from the work of the Institute for Clinical and Economic Review (ICER), a private, nonprofit organization that evaluates pharmaceuticals and other technologies and uses QALYs in its cost-effectiveness assessments. Thus, it remains important to appreciate the strengths and limitations of QALYs, why this metric is not going away, and what QALYs may portend for the future of health policy and medical practice.