BACKGROUND: Quality-adjusted life years (QALYs) have been widely used in cost-effectiveness analyses (CEAs). Nonetheless, critics argue that this measure may inherently discriminate against people with disabilities. OBJECTIVES: To investigate whether the use of QALYs disadvantages disabled populations through combining theoretical analysis with examination of empirical evidence. METHODS: For the theoretical analysis, we constructed five scenarios to compare incremental QALYs between disabled and non-disabled patients reflecting different treatment effects on health-related quality of life or survival. We then searched the Tufts CEA Registry to identify published CEAs for selected chronic diseases including rheumatoid arthritis, type 2 diabetes, and chronic kidney disease to match published evidence with these scenarios. RESULTS: Across five scenarios, the differences in incremental QALYs between disabled and non-disabled groups were driven by relative changes in utility and life years, rather than indicating a systematic bias. In 9 of 11 published CEAs, the disabled subgroup achieved greater incremental QALY, lower (more favorable) ICERs, or dominant results. CONCLUSIONS: These findings suggest that, within the theoretical scenarios and empirical contexts examined, QALY-based CEAs do not appear to inherently disadvantage patients with disabilities.
Yh et al. (Tue,) studied this question.