Cost per quality-adjusted life year and disability-adjusted life years: the need for a new paradigm

2003 ◽  
Vol 3 (4) ◽  
pp. 469-477 ◽  
Author(s):  
Gwyn Bevan ◽  
Sandra Hollinghurst
Author(s):  
Scott Burris ◽  
Micah L. Berman ◽  
Matthew Penn, and ◽  
Tara Ramanathan Holiday

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.


2020 ◽  
Vol 36 (2) ◽  
pp. 96-103 ◽  
Author(s):  
Xue Feng ◽  
David D. Kim ◽  
Joshua T. Cohen ◽  
Peter J. Neumann ◽  
Daniel A. Ollendorf

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.


2021 ◽  
Vol 24 (3) ◽  
pp. 353-360
Author(s):  
Maša Davidović ◽  
Nadine Zielonke ◽  
Iris Lansdorp-Vogelaar ◽  
Nereo Segnan ◽  
Harry J. de Koning ◽  
...  

2020 ◽  
Vol 5 (7) ◽  
pp. e003259 ◽  
Author(s):  
Sanjay G Reddy

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.


Biomedicines ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 111
Author(s):  
Aida Muntsant ◽  
Francesc Jiménez-Altayó ◽  
Lidia Puertas-Umbert ◽  
Elena Jiménez-Xarrie ◽  
Elisabet Vila ◽  
...  

Life expectancy decreases with aging, with cardiovascular, mental health, and neurodegenerative disorders strongly contributing to the total disability-adjusted life years. Interestingly, the morbidity/mortality paradox points to females having a worse healthy life expectancy. Since bidirectional interactions between cardiovascular and Alzheimer’s diseases (AD) have been reported, the study of this emerging field is promising. In the present work, we further explored the cardiovascular–brain interactions in mice survivors of two cohorts of non-transgenic and 3xTg-AD mice, including both sexes, to investigate the frailty/survival through their life span. Survival, monitored from birth, showed exceptionally worse mortality rates in females than males, independently of the genotype. This mortality selection provided a “survivors” cohort that could unveil brain–cardiovascular interaction mechanisms relevant for normal and neurodegenerative aging processes restricted to long-lived animals. The results show sex-dependent distinct physical (worse in 3xTg-AD males), neuropsychiatric-like and cognitive phenotypes (worse in 3xTg-AD females), and hypothalamic–pituitary–adrenal (HPA) axis activation (higher in females), with higher cerebral blood flow and improved cardiovascular phenotype in 3xTg-AD female mice survivors. The present study provides an experimental scenario to study the suggested potential compensatory hemodynamic mechanisms in end-of-life dementia, which is sex-dependent and can be a target for pharmacological and non-pharmacological interventions.


Author(s):  
Rajesh Sharma

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.


2020 ◽  
pp. 095646242095298
Author(s):  
Augusto Cesar Lara de Sousa ◽  
Tatiana de Araujo Eleuterio ◽  
José Victor Afonso Coutinho ◽  
Raphael Mendonça Guimarães

To describe the trends of HIV/AIDS metrics related to the burden of disease for Brazil between 1990 and 2017 we conducted a timeseries analysis for HIV/AIDS indicators by extracting data from the Global Burden of Disease study. We calculated traditional prevalence, incidence and mortality rates, the number of years lost by HIV-related deaths (YLL) and disability (YLD), and disability-adjusted life years (DALY). We estimated time series models and assessed the impact of highly active antiretroviral therapy (HAART) on the same indicators. In the set of disability-adjusted life years (DALY), the highest weight of its magnitude was due to YLL. There was a decline, especially after 1996, of DALY, mortality and YLL for HIV/AIDS. However, YLD, incidence, and prevalence increased over the same period. Also, the analysis of interrupted time series showed that the introduction of HAART into health policy had a significant impact on indicators, especially for DALY and YLL. We need to assess the quality of life of people living with HIV, especially among older adults. In addition, we need to focus on primary prevention, emphasizing methods to avoid infection and public policies should reflect this.


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