New Book Highlights the Negative Impacts of Controversial QALY Value Assessment Framework on Patient Access & Affordability

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Pioneer Institute Research Compilation Spotlights How the Quality Adjusted Life Year Methodology Disadvantages Seniors, the Disabled, and Other Vulnerable Patient Populations

APRIL 10, 2023 (BOSTON, MA) – Today, Pioneer Institute released a new compilation of research regarding the impact of the Quality Adjusted Life Year (QALY) methodology on the ability of patients, including some of the most vulnerable patient communities, to access treatments. The Pioneer book, Rationing Medicine: Threats from European Cost-Effectiveness Models to America’s Seniors and other Vulnerable Populations, is authored by Dr. Bill Smith, Senior Fellow and Director of the Life Sciences Initiative at Pioneer Institute, and compiles research and data about the discriminatory nature of the QALY for aging adults, those living with disabilities or rare diseases, and more.

The QALY is a controversial method for assessing the value of medical treatments that is used most notably by the Institute for Clinical and Economic Review (ICER). The QALY methodology rates medicines according to their ability to extend life and improve quality of life by randomly quantifying the cost of providing a patient with one year of perfect health.

“Policymakers and payers can help ensure that patients have access to lifesaving drugs by avoiding the adoption of “one-size-fits-all” cost-effectiveness models, such as the QALY, that arbitrarily assign value and discriminate against patient communities,” said Dr. Bill Smith. “Patients, alongside their physicians and caregivers, should play a significant role in determining the value of therapies in their own lives, as they bear the greatest brunt of the QALY’s discrimination.”

Featuring a new introduction and conclusion from Dr. Bill Smith, the book compiles findings from several Pioneer Institute reports, including:

In Rationing Medicine, Dr. Smith posits that a ban on the use of QALY would be popular across the political spectrum due to its discriminatory nature and potential to threaten access to innovative treatments, likely being one of only a select group of issues with bipartisan support in the 118th Congress.

“Often before patients are even able to access treatment, the QALY methodology discriminates against them and creates barriers to the medicines that can help them manage their symptoms,” said Terry Wilcox, Founder and CEO of Patients Rising and Patients Rising Now. “Ending the use of the QALY to determine the value of treatments is a critical and meaningful step in driving systemic change for patients living with chronic or rare diseases.”

To learn more about Rationing Medicine: Threats from European Cost-Effectiveness Models to America’s Seniors and other Vulnerable Populations, visit

About the Author

Dr. William S. Smith is Senior Fellow and Director of the Life Sciences Initiative at Pioneer Institute. He has 25 years of experience in government and in corporate roles, including as vice president of public affairs and policy at Pfizer, and as a consultant to major pharmaceutical, biotechnology and medical device companies. He held senior staff positions for the Republican House leadership on Capitol Hill, the White House, and in the Massachusetts Governor’s office. He earned his PhD with distinction at The Catholic University of America (CUA).

About Pioneer Institute

Pioneer’s mission is to develop and communicate dynamic ideas that advance prosperity and a vibrant civic life in Massachusetts and beyond. Pioneer’s vision of success is a state and nation where our people can prosper and our society thrive because we enjoy world-class options in education, healthcare, transportation, and economic opportunity, and where our government is limited, accountable and transparent. Pioneer values an America where our citizenry is well-educated and willing to test our beliefs based on facts and the free exchange of ideas, and committed to liberty, personal responsibility, and free enterprise.