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Care Innovation and Access

One of the biggest questions in healthcare is how to determine the value of a medical treatment. How we answer that question has significant implications for patients, as it determines the coverage and reimbursement of a healthcare intervention and the clinical areas where companies will invest in research and development. 

The most common method used to assess value is through cost-effectiveness analyses that utilize the quality-adjusted life-year (QALY). Unfortunately, this metric places a lower value on medical interventions for aging adults, people with chronic conditions and disabilities, and communities of color. Other countries, such as Australia, Canada, and the United Kingdom, use this metric when making nationwide healthcare decisions. Using the QALY skews healthcare systems to cater to healthy working-age people and fails to incorporate the value of treatment to caregivers and society.

The Alliance believes that we should move toward a value-based healthcare system that incentivizes the outcomes that are important to patients and their families. 

The Alliance has fought against the use of QALY in federal decision making and is working with partners to develop meaningful alternatives

  • The Alliance has an educational campaign called ICERFacts that provides information on the impact of using QALY as well as the organizations trying to introduce the metric into the United States. The leading developer of QALY-based assessments in the U.S. is the Institute for Clinical and Economic Review (ICER). 
  • The Alliance has fought against the use of international reference pricing and the Most Favored Nation model. These proposals would implement the QALY-based pricing policies of foreign nations into the United States.
  • The Alliance is a member of the Innovation and Value Initiative (IVI), a nonprofit organization seeking to build a platform to create patient-centered value assessments. These metrics seek to incorporate the views and perspectives of the patient community when determining the value of a medical intervention.

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