Quality-adjusted life years do not inherently disadvantage disabled patients, according to a McMaster University study published September 28, 2026, in the official journal Value in Health. Researchers examined five theoretical treatment scenarios and eleven published cost-effectiveness analyses, finding that QALY-based results depend heavily on treatment effects and disease severity rather than systematically penalizing individuals with disabilities.
McMaster University Study Examines QALY Bias in Healthcare
Lead author Ma, a postdoctoral fellow in health economics at McMaster University in Ontario, Canada, and colleagues analyzed how health economics metrics apply to patient populations with lower baseline utilities. The investigators assessed five hypothetical clinical situations where outcomes measured in QALYs shifted depending on the nature and size of the treatment benefits, instead of systematically putting disabled patients at a disadvantage.
Researchers also reviewed 11 published cost-effectiveness analyses focused on severe chronic conditions. In nine of those eleven analyses, patients with disabilities achieved greater QALY gains and more favorable incremental cost-effectiveness ratios than nondisabled cohorts. “Patients with disabilities, despite lower baseline utilities, can still achieve substantial improvements, often yielding comparable or even greater QALY gains than those without disabilities,” the authors wrote.
Methodological Challenges and Disease Severity Proxies
A primary challenge for the research team was the lack of a universally accepted definition of disability. To address this limitation in their empirical analysis, researchers utilized disease severity as a proxy across three specific chronic conditions: severe rheumatoid arthritis, type 2 diabetes with complications such as cardiovascular events, and advanced chronic kidney disease.
The study authors acknowledged this approach as a limitation. Using chronic disease severity as a proxy may not capture the full spectrum 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 researchers stated.
Broader Healthcare Policy Debates in the United States
The findings arrive amid ongoing debates across the United States regarding the integration of QALYs into health policy decisions. Legislative measures such as the Affordable Care Act and the Inflation Reduction Act have placed explicit restrictions on using QALYs in specific healthcare policy determinations. “These actions underscore the ongoing controversy surrounding the use of QALYs in health policy decisions,” according to the study authors.
Rather than supporting an outright ban on the metric, the researchers advocate for more careful implementation. They emphasize that QALY-based cost-effectiveness analyses are designed to guide decisions within precise clinical and policy contexts, rather than to rank the value of health improvements across vastly different patient populations. “Rather than banning QALYs outright, policy makers should consider prioritizing transparency, requiring subgroup reporting and incorporating complementary equity analyses,” the authors advised.
Frequently Asked Questions About QALYs and Disability
What did the McMaster University study find regarding QALYs and disabilities?
The study found no evidence that QALYs inherently disadvantage people with disabilities. Across five theoretical treatment scenarios and eleven published cost-effectiveness analyses, results varied by treatment effects, and patients with disabilities frequently showed greater QALY gains than nondisabled cohorts.
How did researchers account for the lack of a disability definition?
Researchers used chronic disease severity as a proxy for disability across three conditions: severe rheumatoid arthritis, type 2 diabetes with complications, and advanced chronic kidney disease.
What policy actions have targeted QALYs in the United States?
Certain healthcare policy decisions face limitations regarding QALY utilization due to federal legislation like the Affordable Care Act and the Inflation Reduction Act.
What do the study authors recommend for policymakers?
The authors advise policymakers to prioritize transparency, mandate subgroup reporting, and incorporate complementary equity analyses rather than banning QALYs outright.