Press Releases

JMI and P⁠i⁠oneer Release S⁠t⁠udy Exam⁠i⁠n⁠i⁠ng Drug Ra⁠t⁠⁠i⁠on⁠i⁠ng

By: Logan Padgett / 2020

April 2, 2020

CONTACT: Logan Elizabeth Padgett

JMI and Pioneer Release Study Examining Drug Rationing

Today, JMI and Pioneer Institute co-released a new report, Quality Adjusted Life Years (QALY): The Threat to Older Americans, which examines how the QALY methodology to determine drug treatment value threatens to discriminate against older adults by placing a lower value on treatments that would extend the life of or improve quality of life for older patients.  This clear bias against providing access to therapies to seniors comes at a critical and especially vulnerable time for older Americans given the coronavirus disease (COVID-19).  Authored by Pioneer Institute Visiting Fellow in Life Sciences, Dr. William Smith, the report concludes that the QALY methodology, utilized most notably by the Institute for Clinical and Economic Review (ICER), has the potential to deny seniors’ access to high-quality, life-saving treatments.

The report explores how the use of the QALY methodology would specifically affect those receiving palliative care. While palliative care treatments may significantly improve the quality of life for patients with a serious or life-limiting condition, they often do not extend it. The report illustrates how the QALY methodology contains inherent bias when applied to palliative care:

“Palliative care highlights the problem of using the QALY methodology generally: not every decision made in healthcare should be justified solely based on cost-effectiveness. Human beings make value judgments about how to care for their fellow human beings…These formulas themselves are based upon certain value judgments that human life is less valuable than many Americans think.” (Pg. 3)

The report warns that federal policy proposals that consider the use of QALYs to make treatment access decisions, such as “Medicare for All,” could have disastrous consequences for American seniors. The report concludes:

“Senior citizens who become enrolled in a Medicare for All plan and are then denied valuable treatments based upon a QALY cost-effectiveness review might not share ICER’s view on the value of QALYs. Not only is ICER’s modeling of the value of longevity flawed, they also de-value treatments such as palliative care that are extremely important to older Americans and their families but may not increase longevity.” (Pg. 3)

“We are currently living through one of the greatest health pandemics of our lifetime, and accessing necessary medications is vital to recovering from the Covid-19 virus sweeping the globe. At a time when we should be concentrating on protecting our most vulnerable – the elderly – we should roundly reject any thought of rationing necessary medication based on a subjective ‘quality of life’ measure. We should be ensuring that Florida’s elderly population is never denied a life-saving medication because an algorithm deems that they don’t matter.” –Sal Nuzzo, Vice President of Policy, The James Madison Institute

“What this paper points out is that rationing medicine to seniors is not only foolish from a health perspective, it is also foolish economically.  Increases in longevity for older Americans has contributed far more to the economy than any increased costs to the healthcare system.” – William Smith, Visiting Fellow, Pioneer Institute

The report can be accessed here:

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The James Madison Institute is a 501(c)3 organization dedicated to the advancement of free markets and liberty. The Institute conducts research on such issues as criminal justice, health care, taxes, and regulatory environments.

Pioneer Institute is an independent, non-partisan, privately funded research organization that seeks to improve the quality of life in Massachusetts through civic discourse and intellectually rigorous, data-driven public policy solutions based on free market principles, individual liberty and responsibility, and the ideal of effective, limited and accountable government.