Perspectives of Patients With Cancer on the Quality-Adjusted Life Year as a Measure of Value in Healthcare

Healthcare expenditures in the United States continue to grow; to control costs, there has been a shift away from volume-focused care to value-based care. The incorporation of patient perspectives in the development of value-based healthcare is critical, yet research addressing this issue is limited. This study explores awareness and understanding of patients with cancer about the quality-adjusted life year (QALY), as well as their perspectives regarding the use of the QALY to measure value in healthcare. This cross-sectional study used survey methodology to explore patient awareness, understanding, and perspectives on the QALY. A total of 774 patients with cancer and survivors completed this survey in June and July of 2017. Quantitative and qualitative analyses were conducted. Results showed that there is limited awareness of the QALY among patients with cancer and survivors and minimal understanding of how the QALY is used. Only one quarter of respondents believed that the QALY was a good way to measure value in healthcare. Some participants (5%) stated that the QALY could be personally helpful to them in their own decision making, indicating the possible usefulness of the QALY as a decision aid in cancer care. Nevertheless, participants expressed concern about other decision makers using the QALY to allocate cancer care and resources and maintained a strong desire for autonomy over personal healthcare choices. Although participants believed that the QALY could help them make more informed decisions, there was concern about how it would be used by payers, policymakers, and other decision makers in determining access to care. Implications for policy and research are discussed. •As healthcare has shifted from a focus on volume to a focus on value, organizations are attempting to assess the value of oncology care and related treatment options.•One traditional economic method of measuring value is the quality-adjusted life year (QALY), which combines morbidity (quality of life) with mortality (quantity of life) to estimate the value of a specific health intervention.•The QALY is intended to inform policy decisions about healthcare resource allocation, yet there has been limited research addressing perspectives of patients with cancer regarding the QALY.•This study begins to address this gap in the literature by exploring awareness, understanding, and perspectives of patients with cancer on the QALY.•Incorporating patient perspectives is critical to the deliv