Do QALYs Matter in the U.S.?

Published on: 11/03/2025

QALYs are essential in Europe—but not in the U.S. Here's what really drives MedTech coverage decisions and how to pivot.

QALYs and U.S. reimbursementMedicare coverage criteriaPrivate payer strategyCost-effectiveness in healthcareClinical necessitypayer incentivesshort-term cost savingscoverage decisionsCMSpeer-reviewed evidenceHTA comparisonsprovider economicshospital adoption strategyhow U.S. payers make reimbursement decisionswhy cost-effectiveness models don’t work in the U.S.
Do QALYs Matter in the U.S.?