Skip to main content
Top
Published in: The European Journal of Health Economics 3/2003

01-09-2003 | Original Papers

Time to disable DALYs?

On the use of disability-adjusted life-years in health policy

Author: Carl Hampus Lyttkens

Published in: The European Journal of Health Economics | Issue 3/2003

Login to get access

Abstract

The concept of disability-adjusted life years (DALYs) has rapidly gained in popularity in health policy, and considerable research resources are being allocated to this field. Proponents of DALYs suggest that the measure can be used both as a "gross domestic product of health" and to help in setting priorities in health policy. This study investigates the usefulness of DALYs and contends that DALYs, as the measure is currently understood, cannot be used for either of these two purposes. The DALYs procedure does not produce a useful measure of population health, and its use in priority setting is ethically questionable.
Literature
1.
go back to reference Anand S, Hanson K (1997) Disability-adjusted life years: a critical review. J Health Econ 16:685–702 Anand S, Hanson K (1997) Disability-adjusted life years: a critical review. J Health Econ 16:685–702
2.
go back to reference Anand S, Hanson K (1998) DALYs: efficiency versus equity. World Dev 26:307–310 Anand S, Hanson K (1998) DALYs: efficiency versus equity. World Dev 26:307–310
3.
go back to reference Andersson F, Lyttkens CH (1999) Preferences for equity in health behind a veil of ignorance. Health Econ 8:369–378 Andersson F, Lyttkens CH (1999) Preferences for equity in health behind a veil of ignorance. Health Econ 8:369–378
4.
go back to reference Anonymous (1998) European disability weights project. BIOMED project PL 963253. Newsletter 98–01 Anonymous (1998) European disability weights project. BIOMED project PL 963253. Newsletter 98–01
5.
go back to reference Arnesen T, Nord E (1999) The value of DALY life: problems with ethics and validity of disability adjusted life years. BMJ 319:1423–1425 Arnesen T, Nord E (1999) The value of DALY life: problems with ethics and validity of disability adjusted life years. BMJ 319:1423–1425
6.
go back to reference Bleichrodt H (1997) Health utility indices and equity considerations. J Health Econ 16:65–91 Bleichrodt H (1997) Health utility indices and equity considerations. J Health Econ 16:65–91
7.
go back to reference Bobadilla JL, Cowley P (1995) Designing and implementing packages of essential health services. J Int Dev 7:543–554 Bobadilla JL, Cowley P (1995) Designing and implementing packages of essential health services. J Int Dev 7:543–554
8.
go back to reference Boyd NF, et al (1990) Whose utilities for decision analysis? Med Decis Making 10:58–67 Boyd NF, et al (1990) Whose utilities for decision analysis? Med Decis Making 10:58–67
9.
go back to reference Cairns J (1992) Health, wealth and time preference. Project Appraisal 7:31–40 Cairns J (1992) Health, wealth and time preference. Project Appraisal 7:31–40
10.
go back to reference Cairns J (1994) Valuing future benefits. Health Econ 3:221–229 Cairns J (1994) Valuing future benefits. Health Econ 3:221–229
11.
go back to reference Cropper ML, Aydede SK, Portney PR (1992) Rates of time preference for saving lives. Am Econ Rev 82:469–472 Cropper ML, Aydede SK, Portney PR (1992) Rates of time preference for saving lives. Am Econ Rev 82:469–472
12.
go back to reference Cropper ML, Aydede SK, Portney PR (1994) Preferences for life saving programmes: how the public discounts time and age. J Risk Uncertainty 8:243–265 Cropper ML, Aydede SK, Portney PR (1994) Preferences for life saving programmes: how the public discounts time and age. J Risk Uncertainty 8:243–265
13.
go back to reference Dolan P (1998) The measurement of individual utility and social welfare. J Health Econ 17:39–52 Dolan P (1998) The measurement of individual utility and social welfare. J Health Econ 17:39–52
14.
go back to reference Drèze J, Stern N (1987) The theory of cost-benefit analysis. In: Auerbach AJ, Feldstein M (eds) Handbook of public economics, vol II. Amsterdam: North-Holland, pp 909–989 Drèze J, Stern N (1987) The theory of cost-benefit analysis. In: Auerbach AJ, Feldstein M (eds) Handbook of public economics, vol II. Amsterdam: North-Holland, pp 909–989
15.
go back to reference Drummond MF, et al (1997) Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press Drummond MF, et al (1997) Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press
16.
go back to reference Essink-Bot M-L, et al (2002) Cross-national comparability of burden of disease estimates: the European Disability Weights Project. Bull World Health Organ 80:644–652 Essink-Bot M-L, et al (2002) Cross-national comparability of burden of disease estimates: the European Disability Weights Project. Bull World Health Organ 80:644–652
17.
go back to reference Foster J, Sen A (1997) On economic inequality after a quarter of a century. In: Sen A (eds) On economic inequality. Oxford: Clarendon Foster J, Sen A (1997) On economic inequality after a quarter of a century. In: Sen A (eds) On economic inequality. Oxford: Clarendon
18.
go back to reference Gold MR, et al (eds) (1996) Cost-effectiveness in health and medicine. New York: Oxford University Press Gold MR, et al (eds) (1996) Cost-effectiveness in health and medicine. New York: Oxford University Press
19.
go back to reference Gravelle H, Smith D (2001) Discounting for health effects in cost-benefit and cost-effectiveness analysis. Health Econ 10:587–599 Gravelle H, Smith D (2001) Discounting for health effects in cost-benefit and cost-effectiveness analysis. Health Econ 10:587–599
20.
go back to reference Gyrd-Hansen D, Søgaard J (1998) Discounting life-years: wither time preferences? Health Econ 7:121–127 Gyrd-Hansen D, Søgaard J (1998) Discounting life-years: wither time preferences? Health Econ 7:121–127
21.
go back to reference Höjgård S, et al (2002) Discounting and clinical decision making. Health Econ 11:355–370 Höjgård S, et al (2002) Discounting and clinical decision making. Health Econ 11:355–370
22.
go back to reference Johannesson M, Gerdtham U-G (1996) A note on the estimation of the equity-efficiency trade-off for QALYs. J Health Econ 15:359–368 Johannesson M, Gerdtham U-G (1996) A note on the estimation of the equity-efficiency trade-off for QALYs. J Health Econ 15:359–368
23.
go back to reference Johannesson M, Jönsson B, Karlsson G (1996) Outcome measurement in economic evaluation. Health Econ 5:279–296 Johannesson M, Jönsson B, Karlsson G (1996) Outcome measurement in economic evaluation. Health Econ 5:279–296
24.
go back to reference Kenkel D (1997) On valuing morbidity, cost-effectiveness analysis, and being rude. J Health Econ 16:749–757 Kenkel D (1997) On valuing morbidity, cost-effectiveness analysis, and being rude. J Health Econ 16:749–757
25.
go back to reference Lindholm L, Rosén M (1998) On the measurement of the nation's equity adjusted health. Health Econ 7:621–228 Lindholm L, Rosén M (1998) On the measurement of the nation's equity adjusted health. Health Econ 7:621–228
26.
go back to reference Lyttkens CH (1994) Prioritering i etik och praktik—en hälsoekonomisk analys av prioriteringsutredningen. Ekonomisk Debatt 22:595–606 Lyttkens CH (1994) Prioritering i etik och praktik—en hälsoekonomisk analys av prioriteringsutredningen. Ekonomisk Debatt 22:595–606
27.
go back to reference Lyttkens CH (1994) QALY league tables. Health Econ 3:57–58 Lyttkens CH (1994) QALY league tables. Health Econ 3:57–58
28.
go back to reference Lyttkens CH (1998) Economic analysis of socio-economic differences in health. In: Arve-Parès B (ed) Inequality in health—a Swedish perspective. Stockholm: Swedish Council for Social Research, pp 285–317 Lyttkens CH (1998) Economic analysis of socio-economic differences in health. In: Arve-Parès B (ed) Inequality in health—a Swedish perspective. Stockholm: Swedish Council for Social Research, pp 285–317
29.
go back to reference Meltzer D (1997) Accounting for future costs in medical cost-effectiveness analysis. J Health Econ 16:33–64 Meltzer D (1997) Accounting for future costs in medical cost-effectiveness analysis. J Health Econ 16:33–64
30.
go back to reference Mooney G, Wiseman V (2000) Burden of disease and priority setting. Health Econ 9:369–372 Mooney G, Wiseman V (2000) Burden of disease and priority setting. Health Econ 9:369–372
31.
go back to reference Mooney G, Irwig L, Leeder S (1997) Priority setting in health care: unburdening from the burden of disease. Aus N Z J Public Health 21:680–681 Mooney G, Irwig L, Leeder S (1997) Priority setting in health care: unburdening from the burden of disease. Aus N Z J Public Health 21:680–681
32.
go back to reference Murray CJL (1996) Rethinking DALYs. In: Murray CJL, Lopez AD (eds) The global burden of disease. Cambridge: Harvard University Press, pp 1–98 Murray CJL (1996) Rethinking DALYs. In: Murray CJL, Lopez AD (eds) The global burden of disease. Cambridge: Harvard University Press, pp 1–98
33.
go back to reference Murray CJL, Acharya AK (1997) Understanding DALYs. J Health Econ 16:703–730 Murray CJL, Acharya AK (1997) Understanding DALYs. J Health Econ 16:703–730
34.
go back to reference Murray CJL, Lopez AD (eds) (1996) The global burden of disease. Cambridge: Harvard University Press Murray CJL, Lopez AD (eds) (1996) The global burden of disease. Cambridge: Harvard University Press
35.
go back to reference Murray CJL, Lopez AD (2000) Progress and directions in refining the global burden of disease approach: a response to Williams. Health Econ 9:69–82 Murray CJL, Lopez AD (2000) Progress and directions in refining the global burden of disease approach: a response to Williams. Health Econ 9:69–82
36.
go back to reference Murray CJL, Salomon JA, Mathers C (1999) A critical examination of summary measures of population health. GPE discussion paper no 2. Geneva: World Health Organization Murray CJL, Salomon JA, Mathers C (1999) A critical examination of summary measures of population health. GPE discussion paper no 2. Geneva: World Health Organization
37.
go back to reference Nord E (1995) The person-trade-off approach to valuing health care programs. Med Decis Making 15:201–208 Nord E (1995) The person-trade-off approach to valuing health care programs. Med Decis Making 15:201–208
38.
go back to reference Nord E (1999) Cost-value analysis in health care. New York: Cambridge University Press Nord E (1999) Cost-value analysis in health care. New York: Cambridge University Press
39.
go back to reference Nord E (1999) My goodness—and yours. A history, and some possible futures, of DALY meanings and valuation procedures. Paper for WHO's Global Conference on Summary Measures of Population health, Marrakech, December Nord E (1999) My goodness—and yours. A history, and some possible futures, of DALY meanings and valuation procedures. Paper for WHO's Global Conference on Summary Measures of Population health, Marrakech, December
40.
go back to reference Nord E, et al (1995) Maximizing health benefits vs egalitarianism: an Australian survey of health issues. Soc Sci Med 41:1429–1437 Nord E, et al (1995) Maximizing health benefits vs egalitarianism: an Australian survey of health issues. Soc Sci Med 41:1429–1437
41.
go back to reference Nord E, et al (1999) Incorporating societal concerns for fairness in numerical valuations of health programmes. Health Econ 8:25–39 Nord E, et al (1999) Incorporating societal concerns for fairness in numerical valuations of health programmes. Health Econ 8:25–39
42.
go back to reference Olsen JA (1993) On what basis should health be discounted. J Health Econ 12:39–53 Olsen JA (1993) On what basis should health be discounted. J Health Econ 12:39–53
43.
go back to reference Olsen JA (1993) Time preferences for health gains: an empirical investigation. Health Econ 2:257–265 Olsen JA (1993) Time preferences for health gains: an empirical investigation. Health Econ 2:257–265
44.
go back to reference Olsen JA (1994) Persons vs years: two ways of eliciting implicit weights. Health Econ 3:39–46 Olsen JA (1994) Persons vs years: two ways of eliciting implicit weights. Health Econ 3:39–46
45.
go back to reference Olsen JA (1997) Theories of justice and their implications for priority setting in health care. J Health Econ 16:625–639 Olsen JA (1997) Theories of justice and their implications for priority setting in health care. J Health Econ 16:625–639
46.
go back to reference Peterson S, Backlund I, Diderichsen F (1998) Sjukdomsbördan i Sverige—en svensk DALY-kalkyl [The burden of disease in Sweden—a Swedish DALY-calculation]. Stockholm: Folkhälsoinstitutet Peterson S, Backlund I, Diderichsen F (1998) Sjukdomsbördan i Sverige—en svensk DALY-kalkyl [The burden of disease in Sweden—a Swedish DALY-calculation]. Stockholm: Folkhälsoinstitutet
47.
go back to reference Pol MM van der, Cairns J (2000) Negative and zero time preferences for health. Health Econ 9:171–175 Pol MM van der, Cairns J (2000) Negative and zero time preferences for health. Health Econ 9:171–175
48.
go back to reference Redelmeier DA, Heller DM (1993) Time preference in medical decision making and cost-effectiveness analysis. Med Decis Making 13:212–303 Redelmeier DA, Heller DM (1993) Time preference in medical decision making and cost-effectiveness analysis. Med Decis Making 13:212–303
49.
go back to reference Sacket DL, Torrance GW (1978) The utility of different health states as perceived by the general public. J Chronic Dis 31:697–704 Sacket DL, Torrance GW (1978) The utility of different health states as perceived by the general public. J Chronic Dis 31:697–704
50.
go back to reference Ubel PA, Richardson J, Menzel P (2000) Societal value, the person trade-off and the dilemma of whose values to measure for cost-effectiveness analysis. Health Econ 9:127–136 Ubel PA, Richardson J, Menzel P (2000) Societal value, the person trade-off and the dilemma of whose values to measure for cost-effectiveness analysis. Health Econ 9:127–136
51.
go back to reference Vårdens svåra val [The difficult choice in health care]. SOU 1995:5. Stockholm: Slutbetänkande av Prioriteringsutredningen. Vårdens svåra val [The difficult choice in health care]. SOU 1995:5. Stockholm: Slutbetänkande av Prioriteringsutredningen.
52.
go back to reference Wagstaff A (1991) QALYs and the equity-efficiency trade-off. J Health Econ 10:21–41 Wagstaff A (1991) QALYs and the equity-efficiency trade-off. J Health Econ 10:21–41
53.
go back to reference Williams A (1988) Ethics and efficiency in the provision of health care. In: Bell JM, Mendus S (eds) Philosophy and medical care, supplement to Philosophy Williams A (1988) Ethics and efficiency in the provision of health care. In: Bell JM, Mendus S (eds) Philosophy and medical care, supplement to Philosophy
54.
go back to reference Williams A (1997) Intergenerational equity: an exploration of the 'fair innings' argument. Health Econ 6:117–132 Williams A (1997) Intergenerational equity: an exploration of the 'fair innings' argument. Health Econ 6:117–132
55.
go back to reference Williams A (1999) Calculating the global burden of disease: time for a strategic reappraisal? Health Econ 8:1–8 Williams A (1999) Calculating the global burden of disease: time for a strategic reappraisal? Health Econ 8:1–8
56.
go back to reference Williams A (2000) Comments on the response by Murray and Lopez. Health Econ 9:83–86 Williams A (2000) Comments on the response by Murray and Lopez. Health Econ 9:83–86
57.
go back to reference World Bank (1993) World development report 1993. Investing in health. New York: Oxford University Press World Bank (1993) World development report 1993. Investing in health. New York: Oxford University Press
58.
go back to reference World Health Organization (2002) World health report 2002. Reducing risks, promoting healthy life. Statistical Annex, p 172. www.who.int/whr/2002/en/, accessed 28 January 2003 World Health Organization (2002) World health report 2002. Reducing risks, promoting healthy life. Statistical Annex, p 172. www.who.int/whr/2002/en/, accessed 28 January 2003
Metadata
Title
Time to disable DALYs?
On the use of disability-adjusted life-years in health policy
Author
Carl Hampus Lyttkens
Publication date
01-09-2003
Publisher
Springer-Verlag
Published in
The European Journal of Health Economics / Issue 3/2003
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-003-0169-2

Other articles of this Issue 3/2003

The European Journal of Health Economics 3/2003 Go to the issue