Concepts
Quality-Adjusted Life Year
Also Known As QALY
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The quality-adjusted life year (QALY) is a generic measure of disease burden that combines the quality and the quantity of life lived into one number: one QALY equals one year lived in perfect health, calculated by multiplying the change in health utility a treatment produces by the duration of that effect, on a scale running from 1 (perfect health) to 0 (dead). The idea grew across several contributors, from Klarman and colleagues in 1968 through Fanshel and Bush in 1970 and Torrance and colleagues in 1972, with Joseph Pliskin's 1974 Harvard doctoral thesis carrying the first known mention of QALYs by that name and a 1976 article by Zeckhauser and Shepard giving the term its first appearance in print. Disability-rights advocates have criticized the measure because an otherwise healthy person can never return to full health or reach a high QALY score from an already-impaired baseline, a concern sharpened wherever a health system, such as the United Kingdom's National Institute for Health and Care Excellence since 1999, uses a pound-or-dollar-per-QALY threshold to decide which treatments it will fund.
The measure itself, its formula and its history are settled; what is genuinely debated is whether using it to allocate scarce health resources is fair to people with disabilities. See the linked open question and dissent for both sides.
Facts
First Described YearSourced to the subject's own account Concept ClassSourced to the subject's own accountBurden of Disease Measure 1 Cross-Tradition Connections
Associated With
Both are summary health-burden measures combining length and quality or severity of life into one number; DALYs measure burden lost, QALYs measure healthy years gained.
In Branch
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Open Questions (1 open question)
Does allocating scarce health-system resources by a QALY-based cost-effectiveness threshold structurally undervalue treatment for people with disabilities, who by definition can rarely reach the "perfect health" baseline a QALY is scored against?
Disability-rights advocates argue the QALY's own arithmetic discriminates: a treatment that moves a person with a permanent disability from a lower baseline toward the best health realistically available to them will almost always generate fewer QALYs than the identical intervention given to someone who can reach a full 1.0 score, so a strict per-QALY funding threshold systematically ranks disabled patients' care lower regardless of how much the treatment actually helps them. Health economists who defend the measure argue any health system faces a finite budget, that QALYs are the least-bad common currency for comparing wildly different interventions on relative value for money, and that the alternative, funding decisions with no explicit metric at all, is not more fair, only less transparent about the trade-offs it is already making. Both positions appear across the literature and in real policy: the United Kingdom's National Institute for Health and Care Excellence has used a pound-p
What would resolve this A structured comparison of health outcomes for disabled populations under strict QALY-threshold rationing against outcomes under an explicit disability-weighted or equity-adjusted alternative, paired with a settled legal and ethical consensus on whether unadjusted QALY-based allocation itself constitutes disability discrimination or merely a value-neutral budget constraint.
Health Economics, Disability Studies, BioethicsWikipedia: Quality-Adjusted Life Year
Dissenting Readings (1 dissenting reading)
Description
The description above states what a QALY is and how it is calculated, but leaves unsaid that disability-rights advocates hold the measure's use in funding decisions to be discriminatory by construction: since a person with a permanent disability typically cannot reach the perfect-health ceiling a QALY is scored against, the identical clinical benefit yields fewer QALYs for a disabled patient than for a non-disabled one, so a strict cost-per-QALY funding threshold ranks their care lower purely as an artifact of the scoring, not of the treatment's real value to them. Health economists reply that QALYs remain the least-bad common currency available for comparing incommensurable interventions under a genuinely finite budget, and that the objection, taken to its conclusion, does not identify a fairer alternative so much as it asks for the trade-off to be made less explicit. See the linked open question for the concrete cases, NICE's threshold since 1999 and Oregon's 1989 Medicaid ranking found to violate the ADA in 1992, and what would settle it.
A dissenting reading, from an independent laneWikipedia: Quality-Adjusted Life Year, Wikipedia
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