Calculating disability-adjusted-life-years lost (DALYs) in discrete-time

Cost Effectiveness and Resource Allocation

Bruce A Larson¹ 

[1] Department of International Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA

关键词: Cost-effectiveness;    Discrete time;    Disability adjusted life years lost;   

Others  :  810594
DOI  :  10.1186/1478-7547-11-18

 received in 2013-06-24, accepted in 2013-07-29,  发布年份 2013

【 摘 要 】

Disability-adjusted-life-years lost (DALYs) is a common outcome metric for cost-effectiveness analyses, and the equations used for such calculations have been presented previously by Fox-Rushby and Hanson (see, e.g., “Health Policy and Planning 16:326–331, 2001”). While the equations are clear, the logic behind them is opaque at best for a large share of public health practitioners and students. The objective of this paper is to show how to calculate DALYs using a discrete time formulation that is easy to teach to students and public health practitioners, is easy to apply for those with basic discounting skills, and is consistent with the discounting methods typically included on the costing side of cost-effectiveness analysis. A continuous-time adjustment factor is derived that can be used to ensure exact consistency between the continuous and discrete time approaches, but this level of precision is typically unnecessary for cost-effectiveness analyses. To illustrate the approach, both a new, simple example and the same example presented in Fox-Rushby and Hanson are used throughout the paper.

【 授权许可】

   
2013 Larson; licensee BioMed Central Ltd.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]World Bank: World Development Report, Investing in Health 1993. New York, New York: Published for the World Bank, Oxford University Press; 1993.
• [2]Murray CJ: Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ 1994, 72(3):429-45.
• [3]Murray CJ, Acharya AK: Understanding DALYs (disability-adjusted life years). J Health Econ 1997, 16(6):703-30.
• [4]Fox-Rushby J, Hanson K: Calculating and presenting disability adjusted life years (DALYs) in cost-effectiveness analysis. Health Policy Plan 2001, 16(3):326-331.
• [5]Phanthunane P, et al.: Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia. Cost Effectiveness and Resource Allocation 2011, 9(1):6. BioMed Central Full Text
• [6]Amarasinghe A: Cost-effectiveness implications of GP intervention to promote physical activity: evidence from Perth. Australia. Cost Effectiveness and Resource Allocation 2010, 8(1):10. BioMed Central Full Text
• [7]Rubinstein A, et al.: Generalized cost-effectiveness analysis of a package of interventions to reduce cardiovascular disease in Buenos Aires. Argentina. Cost Effectiveness and Resource Allocation 2009, 7(1):10. BioMed Central Full Text
• [8]Bachmann M: Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model. Cost Effectiveness and Resource Allocation 2009, 7(1):2. BioMed Central Full Text
• [9]Hansen K, Chapman G: Setting priorities for the health care sector in Zimbabwe using cost-effectiveness analysis and estimates of the burden of disease. Cost Effectiveness and Resource Allocation 2008, 6(1):14. BioMed Central Full Text
• [10]Dalziel K, Segal L, Mortimer D: Review of Australian health economic evaluation - 245 interventions: what can we say about cost effectiveness? Cost Effectiveness and Resource Allocation 2008, 6(1):9. BioMed Central Full Text
• [11]Robberstad B, Hemed Y, Norheim O: Cost-effectiveness of medical interventions to prevent cardiovascular disease in a sub-Saharan African country - the case of Tanzania. Cost Effectiveness and Resource Allocation 2007, 5(1):3. BioMed Central Full Text
• [12]Bishai D, Hyder A: Modeling the cost effectiveness of injury interventions in lower and middle income countries: opportunities and challenges. Cost Effectiveness and Resource Allocation 2006, 4(1):2. BioMed Central Full Text
• [13]Shim E, et al.: Evaluating the cost-effectiveness of rabies post-exposure prophylaxis: A case study in Tanzania. Vaccine 2009, 27(51):7167-7172.
• [14]Elbasha EH: Discrete time representation of the formula for calculating DALYs. Health Econ 2000, 9(4):353-365.
• [15]Drummond MF: Methods for the Economic Evaluation of Health Care Programmes. 3rd edition. Oxford: Oxford University Press; 2005.
• [16]Mathers CD, et al.: Chapter 5: Sensitivity and Uncertainty Analyses for Burden of Disease and Risk Factor Estimates. In Global Burden of Disease and Risk Factors. Edited by Lopez AD. Washington, D.C: The World Bank; 2006.