Important barriers to the use of QALYs in the United States include concerns about disability and age discrimination.Modifications to the utility function underlying QALYs have been proposed to mitigate these concerns, but some find them challenging to consider and/or to apply.Unrelated to these concerns, QALYs have been adapted within the framework of distributional cost-effectiveness analysis to allow consideration of inequality as well as efficiency.I outline how this framework can also remediate concerns about disability and age discrimination.
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