Quality-adjusted life years (QALYs) used in health economics do not inherently disadvantage patients with disabilities, according to a study published in the September 2026 issue of Value in Health. Researchers found that QALY-based results varied by treatment effects rather than consistently penalizing disabled cohorts, challenging long-standing criticisms of the metric in health policy decisions.
Evaluation of QALYs Across Treatment Scenarios
The study, titled “Do Quality-Adjusted-Life-Year-Based Cost-Effectiveness Analyses Discriminate Against Disabled Patients? A Theoretical and Empirical Analysis,” was authored by Yue Ma, PhD, and colleagues. Published by ISPOR—The Professional Society for Health Economics and Outcomes Research, the research examined the impact of QALYs through five theoretical treatment scenarios and eleven published cost-effectiveness analyses.
Lead author Yue Ma, a postdoctoral fellow in health economics at McMaster University in Ontario, Canada, noted that patients with disabilities can achieve substantial health improvements despite lower baseline utilities. According to the findings, these improvements frequently yield comparable or greater QALY gains than those seen in nondisabled cohorts.
The QALY combines gains in length of life and health-related quality of life into a single metric to assess health interventions. Critics historically argued that the measure underestimates treatment benefits for people with disabilities because lower baseline health scores could translate into smaller overall QALY gains. However, the five theoretical scenarios tested by Ma and colleagues demonstrated that results fluctuate based on specific treatment effects—such as improved health-related quality of life, extended survival, or both—rather than systematically disadvantaging disabled individuals.
Empirical Analysis Using Chronic Disease Severity as a Proxy
Because a universally accepted definition of disability is absent in the literature, researchers utilized disease severity as a pragmatic proxy across three chronic conditions: severe rheumatoid arthritis, type 2 diabetes with complications such as cardiovascular events, and advanced chronic kidney disease. Out of 11 published cost-effectiveness analyses evaluated in the empirical portion, 9 showed that patients with severe chronic conditions experienced greater QALY gains and more favorable incremental cost-effectiveness ratios than nondisabled comparison groups.
The study authors acknowledged limitations in using chronic disease severity as a proxy for disability. This approach may not capture the full scope of disability experiences, including intellectual and developmental disabilities, traumatic injuries, cognitive impairment associated with aging, or end-of-life conditions.
“Measuring and valuing health in persons with disabilities raises distinct ethical and methodological challenges. Future research on QALY-based discrimination should examine these issues and develop methods better suited to capturing health outcomes, preferences, and values,” the authors wrote.
Implications for US Healthcare Policy and Decision-Making
The findings arrive amid ongoing policy debates in the United States regarding the integration of QALYs into healthcare decisions. Legislative measures such as the Affordable Care Act and the Inflation Reduction Act have placed restrictions on the use of QALYs in certain federal and state healthcare policy frameworks.
Rather than supporting outright bans on the metric, the researchers advocate for more careful implementation. They emphasize that QALY-based cost-effectiveness analyses are designed to guide decisions within specific clinical and policy contexts, rather than to rank the value of health improvements across disparate patient populations.
“Rather than banning QALYs outright, policy makers should consider prioritizing transparency, requiring subgroup reporting and incorporating complementary equity analyses,” the authors advised.
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