scholarly journals Disability-Adjusted Life Years Averted Versus Quality-Adjusted Life Years Gained: A Model Analysis for Breast Cancer Screening

2021 ◽  
Vol 24 (3) ◽  
pp. 353-360
Author(s):  
Maša Davidović ◽  
Nadine Zielonke ◽  
Iris Lansdorp-Vogelaar ◽  
Nereo Segnan ◽  
Harry J. de Koning ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Model Analysis ◽  
Disability Adjusted Life Years ◽  
Quality Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Quality Adjusted Life

Breast Cancer Screening: Beyond Mortality

2019 ◽  
Vol 1 (3) ◽  
pp. 161-165 ◽  
Author(s):  
Martin J Yaffe ◽  
Roberta A Jong ◽  
Kathleen I Pritchard
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Quality Adjusted Life Years ◽  
Younger Women ◽  
Life Years ◽  
Alternative Measures ◽  
Quality Adjusted Life

Abstract Traditionally, the effectiveness of breast cancer screening has been measured in terms of reducing the number of deaths attributable to breast cancer. Other metrics such as the number of life-years or quality-adjusted life-years gained through screening may be more relevant and certainly may better reflect the important burden of the disease on younger women, their families, and society. The effects of earlier detection of breast cancer in reducing morbidities associated with treatment have often also been neglected. In addition, the harms and limitations associated with cancer screening have been poorly quantified and are seldom put into perspective vis-à-vis the benefits. Here, these alternative measures will be discussed and quantified.

The impact of a breast cancer screening programme on quality-adjusted life-years

1991 ◽  
Vol 49 (4) ◽  
pp. 538-544 ◽  
Author(s):  
J. C. J. M. de Haes ◽  
Harry J. de Koning ◽  
Gerrit J. van Oortmarssen ◽  
Heleen M. E. van Agt ◽  
Arry E. de Bruyn ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Screening Programme ◽  
Quality Adjusted Life Years ◽  
Breast Cancer Screening Programme ◽  
Life Years ◽  
Cancer Screening Programme ◽  
The Impact ◽  
Quality Adjusted Life

Identifying Public Health Problems

2018 ◽  
Author(s):  
Scott Burris ◽  
Micah L. Berman ◽  
Matthew Penn, and ◽  
Tara Ramanathan Holiday
Keyword(s):  
Public Health ◽  
Health Problems ◽  
Health Priorities ◽  
Disability Adjusted Life Years ◽  
Quality Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Study Designs ◽  
Quality Adjusted Life

Chapter 5 discusses the use of epidemiology to identify the source of public health problems and inform policymaking. It uses a case study to illustrate how researchers, policymakers, and practitioners detect diseases, identify their sources, determine the extent of an outbreak, and prevent new infections. The chapter also defines key measures in epidemiology that can indicate public health priorities, including morbidity and mortality, years of potential life lost, and measures of lifetime impacts, including disability-adjusted life years and quality-adjusted life years. Finally, the chapter reviews epidemiological study designs, differentiating between experimental and observational studies, to show how to interpret data and identify limitations.

scholarly journals Using QALYs versus DALYs to measure cost-effectiveness: How much does it matter?

2020 ◽  
Vol 36 (2) ◽  
pp. 96-103 ◽  
Author(s):  
Xue Feng ◽  
David D. Kim ◽  
Joshua T. Cohen ◽  
Peter J. Neumann ◽  
Daniel A. Ollendorf
Keyword(s):  
Cost Effectiveness ◽  
Medical Center ◽  
Disability Adjusted Life Years ◽  
Quality Adjusted Life Years ◽  
Effectiveness Analysis ◽  
Disability Weights ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Relative Differences ◽  
Quality Adjusted Life

ObjectivesQuality-adjusted life-years (QALYs) and disability-adjusted life-years (DALYs) are commonly used in cost-effectiveness analysis (CEA) to measure health benefits. We sought to quantify and explain differences between QALY- and DALY-based cost-effectiveness ratios, and explore whether using one versus the other would materially affect conclusions about an intervention's cost-effectiveness.MethodsWe identified CEAs using both QALYs and DALYs from the Tufts Medical Center CEA Registry and Global Health CEA Registry, with a supplemental search to ensure comprehensive literature coverage. We calculated absolute and relative differences between the QALY- and DALY-based ratios, and compared ratios to common benchmarks (e.g., 1× gross domestic product per capita). We converted reported costs into US dollars.ResultsAmong eleven published CEAs reporting both QALYs and DALYs, seven focused on pharmaceuticals and infectious disease, and five were conducted in high-income countries. Four studies concluded that the intervention was “dominant” (cost-saving). Among the QALY- and DALY-based ratios reported from the remaining seven studies, absolute differences ranged from approximately $2 to $15,000 per unit of benefit, and relative differences from 6–120 percent, but most differences were modest in comparison with the ratio value itself. The values assigned to utility and disability weights explained most observed differences. In comparison with cost-effectiveness thresholds, conclusions were consistent regardless of the ratio type in ten of eleven cases.ConclusionsOur results suggest that although QALY- and DALY-based ratios for the same intervention can differ, differences tend to be modest and do not materially affect comparisons to common cost-effectiveness thresholds.

scholarly journals Population health, economics and ethics in the age of COVID-19

2020 ◽  
Vol 5 (7) ◽  
pp. e003259 ◽  
Author(s):  
Sanjay G Reddy
Keyword(s):  
Public Health ◽  
Population Health ◽  
Disability Adjusted Life Years ◽  
Quality Adjusted Life Years ◽  
Health Measures ◽  
Balanced Approach ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Aggregate Population ◽  
Quality Adjusted Life

Are the steps that have been taken to arrest the spread of COVID-19 justifiable? Specifically, are they likely to have improved public health understood according to widely used aggregate population health measures, such as Quality Adjusted Life Years (QALYs) and Disability Adjusted Life Years (DALYs) as much or more than alternatives? This is a reasonable question, since such measures have been promoted extensively in global and national health policy by influential actors, and they have become almost synonymous with quantification of public health. If the steps taken against COVID-19 did not meet this test, then either the measures or the policies must be re-evaluated. There are indications that policies against COVID-19 may have been unbalanced and therefore not optimal. A balanced approach to protecting population health should be proportionate in its effects across distinct health concerns at a moment, across populations over time and across populations over space. These criteria provide a guide to designing and implementing policies that diminish harm from COVID-19 while also providing due attention to other threats to aggregate population health. They should shape future policies in response to this pandemic and others.

Examination of incidence, mortality and disability-adjusted life years and risk factors of breast cancer in 49 Asian countries, 1990–2019: estimates from Global Burden of Disease Study 2019

2021 ◽  
Author(s):  
Rajesh Sharma
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Mortality Rate ◽  
Burden Of Disease ◽  
Global Burden ◽  
Disability Adjusted Life Years ◽  
Asian Countries ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Standardized Mortality Rate

Abstract Background This study presents an up-to-date, comprehensive and comparative examination of breast cancer’s temporal patterns in females in Asia in last three decades. Methods The estimates of incidence, mortality, disability-adjusted-life-years and risk factors of breast cancer in females in 49 Asian countries were retrieved from Global Burden of Disease 2019 study. Results In Asia, female breast cancer incidence grew from 245 045[226 259–265 260] in 1990 to 914 878[815 789–1025 502] in 2019 with age-standardized incidence rate rising from 21.2/100 000[19.6–22.9] to 35.9/100 000[32.0–40.2] between 1990 and 2019. The death counts more than doubled from 136 665[126 094–148 380] to 337 822[301 454–375 251]. The age-standardized mortality rate rose marginally between 1990 and 2019 (1990: 12.1[11.0–13.1]; 2019: 13.4[12.0–14.9]). In 2019, age-standardized incidence rate varied from 17.2/100 000[13.95–21.4] in Mongolia to 122.5[92.1–160.7] in Lebanon and the age-standardized mortality rate varied 4-fold from 8.0/100 000 [7.2–8.8] in South Korea to 51.9[39.0–69.8] in Pakistan. High body mass index (5.6%), high fasting plasma glucose (5.6%) and secondhand smoke (3.5%) were the main contributory risk factors to all-age disability-adjusted-life-years due to breast cancer in Asia. Conclusion With growing incidence, escalating dietary and behavioural risk factors and lower survival rates due to late-disease presentation in low- and medium-income countries of Asia, breast cancer has become a significant public health threat. Its rising burden calls for increasing breast cancer awareness, preventive measures, early-stage detection and cost-effective therapeutics in Asia.

Asymptomatic versus symptomatic metastatic breast cancer: Potential effects on prognosis and quality adjusted life years (QALYs).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13073-e13073
Author(s):  
Kosho Yamanouchi ◽  
Shigeto Maeda ◽  
Tamotsu Kuroki
Keyword(s):  
Breast Cancer ◽  
Primary Breast Cancer ◽  
Recurrent Breast Cancer ◽  
Quality Adjusted Life Years ◽  
Asymptomatic Group ◽  
Symptomatic Group ◽  
Life Years ◽  
Recurrent Breast ◽  
Quality Adjusted Life

e13073 Background: After radical surgery for breast cancer, routine laboratory or imaging studies for metastases screening are not indicated in the absence of clinical signs and symptoms suggestive of recurrence. While the goal of therapy is the extension of survival and maintenance of quality of life (QOL), therapies themselves could induce adverse events, resulting in deterioration of QOL. We evaluated quality adjusted life years (QALYs), which is survival adjusted by QOL, of the patients with recurrent breast cancer retrospectively and adequate follow-up measures. Methods: Fifty seven patients with recurrent breast cancer who died already were included. Survival curves were partitioned into two health states: time with ≥ grade 2 chemotherapy-related toxicity (TOX) and time without toxicity (TWiST). QALYs were acquired as follows: QALYs = TWiST + 0.7 * TOX. We compared clinical factors in the patients between with (symptomatic group, n = 32) and without symptoms (asymptomatic group, n = 25). Results: The median age of the patient at diagnosis of recurrence was 57 years. Luminal (hormone receptors (HR) - and human epidermal growth factor receptor-2 (HER2) -), HER2 (HER2 +), triple negative (TN) (HR - and HER2 -), and unknown were 29, 7, 15, and 6 cases, respectively. The proportion of HER2 and TN was significantly higher in the symptomatic group than that in the asymptomatic group (58.6, 21.7 %, p < 0.05). 44.6 % of the patients had visceral metastases at diagnosis of recurrence and the proportions were not different between the groups. Although post recurrent survival (PRS) was shorter significantly in the symptomatic group (22.5, 42,0 months, p < 0.01), overall survival from diagnosis of primary breast cancer (OS) was identical (60.5, 91.0 months). Additionally, QALYs after recurrence was shorter in the symptomatic group (23.0, 41.1 months, p < 0.01) and QALYs from diagnosis of primary breast cancer was identical (58.7, 91.0 months). Conclusions: Although there was no significant difference in OS between the both groups, the duration of therapy received was longer in the symptomatic group. In the present study, we acquired limited information due to retrospective manner. Prospective evaluation of QALYs, including patient reported outcome and symptoms derived from cancer itself, would turn out adequate measures of follow-up after radical surgery for primary breast cancer.

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