I don’t know a lot about this bill specifically, but here’s my sense:
This bill has been pushed by disability activists, who are opposed to things like QALYs, which they consider ableist. Steve Pearson nicely summarizes why here:
Since the early days of CEA experts recognized that any extension of life for patients with a persistent disability would be “weighted” in the QALY by the (lower) quality of life assigned to that health state. For example, a treatment that extends life — but does not improve quality of life — for patients with a condition that requires mechanical ventilation would be assigned a lower QALY gain that a treatment that extends life exactly the same amount for patients with rheumatoid arthritis or cancer.
This bill currently has no democratic co-sponsors in the House (although this article says that there is “bipartisan interest”), and I do not think it has been introduced in the Senate. Thus, I suspect this bill is unlikely to get passed under a democratic administration, but I’m not sure about that.
Here is some background:
US health care spending is out of control ($4.3 trillion; 18.3% of GDP in 2021); this is a massive, intractable problem, and this bill would certainly not help.
I do not think QALYs are super widely used in the US health care system as is. H.R. 485 represents an expansion of existing restrictions (see page 47) on the use of cost-effectiveness analysis in Medicare and other federal programs; the goal of this legislation is to fully ban the use of QALYs across all federal programs, which I think would include state Medicaid programs, since Medicaid is jointly financed by states and the federal government.
Even in the absence of this bill, there is significant public opposition to the use of QALYs and similar metrics in US health care. (Health care rationing remains a very loaded issue in US politics.)
In terms of things that are wrong with the US health care system, failure to use QALYs is a problem, but I think other things are bigger contributors to the widespread provision of low-value care.
If this bill were to pass, I think (?) it’d still be possible to use things like evLYGs, which could play a similar role as QALYs in cost-effectiveness analysis, but “evenly measure any gains in length of life, regardless of the treatment’s ability to improve patients’ quality of life.”
Tl;dr: I think passing this bill might be akin to shooting holes in the tires of a car that only had two wheels to begin with, and it currently looks unlikely to pass.
I don’t know a lot about this bill specifically, but here’s my sense:
This bill has been pushed by disability activists, who are opposed to things like QALYs, which they consider ableist. Steve Pearson nicely summarizes why here:
This bill currently has no democratic co-sponsors in the House (although this article says that there is “bipartisan interest”), and I do not think it has been introduced in the Senate. Thus, I suspect this bill is unlikely to get passed under a democratic administration, but I’m not sure about that.
Here is some background:
US health care spending is out of control ($4.3 trillion; 18.3% of GDP in 2021); this is a massive, intractable problem, and this bill would certainly not help.
I do not think QALYs are super widely used in the US health care system as is. H.R. 485 represents an expansion of existing restrictions (see page 47) on the use of cost-effectiveness analysis in Medicare and other federal programs; the goal of this legislation is to fully ban the use of QALYs across all federal programs, which I think would include state Medicaid programs, since Medicaid is jointly financed by states and the federal government.
Even in the absence of this bill, there is significant public opposition to the use of QALYs and similar metrics in US health care. (Health care rationing remains a very loaded issue in US politics.)
In terms of things that are wrong with the US health care system, failure to use QALYs is a problem, but I think other things are bigger contributors to the widespread provision of low-value care.
If this bill were to pass, I think (?) it’d still be possible to use things like evLYGs, which could play a similar role as QALYs in cost-effectiveness analysis, but “evenly measure any gains in length of life, regardless of the treatment’s ability to improve patients’ quality of life.”
Tl;dr: I think passing this bill might be akin to shooting holes in the tires of a car that only had two wheels to begin with, and it currently looks unlikely to pass.