Economic Evaluation Webcast Part 5 of 5: Cost-Effectiveness Analysis
Summary
TLDREl análisis económico es un componente esencial en la toma de decisiones y la formulación de políticas de salud. Este script explora dos tipos de evaluaciones económicas: el análisis costo-beneficio y el análisis costo-efectividad. Mientras que el primero convierte los resultados en dólares, el segundo expresa los resultados en unidades de salud naturales, como casos de enfermedad cardiovascular evitados o vidas salvadas. El análisis costo-efectividad se realiza generalmente en programas que afectan el mismo resultado de salud y su medida resumen es la relación entre los costos netos del programa y sus efectos netos. Además, se aborda el análisis costo-utilidad, que combina todos los resultados de salud en términos de años de vida ajustados por calidad de vida, conocidos como años de vida ajustados por calidad (QALY). Este análisis es útil para comparar intervenciones que afectan diferentes resultados de salud y para establecer umbrales de costo-efectividad. El script también destaca la importancia de los efectos a largo plazo en el análisis costo-efectividad y cómo las decisiones de políticas deben ser sometidas a criterios subjetivos. Finalmente, se menciona el uso de años de vida ajustados por discapacidad (DALY) como medida de impacto en la carga de la enfermedad.
Takeaways
- 📈 La evaluación económica, como el análisis de costo-efectividad, se realiza generalmente después de que un programa, política o intervención haya demostrado ser eficaz y antes de su implementación masiva.
- 🔍 El análisis de costo-efectividad compara los costos de una intervención con sus resultados, expresados en unidades de salud naturales, a diferencia del análisis costo-beneficio que convierte los resultados en dólares.
- ⚖️ Se debe realizar el análisis de costo-efectividad con intervenciones o programas que afecten el mismo resultado de salud para poder compararlos adecuadamente.
- 📊 El medidor resumen en el análisis de costo-efectividad es la relación entre los costos netos del programa divididos por los efectos del programa netos.
- 📉 Los efectos o resultados en el análisis de costo-efectividad pueden definirse de manera estrecha o amplia; se prefieren definiciones amplias para decisiones de política pública.
- 🚫 Una gran advertencia en el análisis de costo-efectividad es que los resultados en unidades naturales no se pueden combinar y deben considerarse por separado.
- 💡 Para abordar el problema de múltiples resultados, se puede realizar un análisis de costo-utilidad, donde los resultados se expresan como un índice de salud que combina todos los resultados de salud en términos de aumentos en la duración y calidad de la vida.
- 📏 Las utilidades, o pesos de preferencia, son una forma de describir cuantitativamente las preferencias del consumidor por una buena calidad de vida y una medida subjetiva de la utilidad resultante de estar en diferentes estados de salud.
- 🤔 El análisis de costo-efectividad es subjetivo en términos de los umbrales que determinan si una intervención es considerada rentable o no, lo que requiere un juicio por parte de los responsables de políticas.
- 📚 Los años de vida ajustados por discapacidad (DALY, por sus siglas en inglés) son otra medida de resultado que se puede usar en el análisis de costo-utilidad, principalmente para medir la carga de la enfermedad y permitir estimaciones comparables entre países.
- 🌟 La evaluación económica es valiosa para la toma de decisiones y la configuración de políticas de salud, y es tanto arte como ciencia, ayudando a priorizar recursos para las estrategias más efectivas.
Q & A
¿Cuándo se realizan las evaluaciones económicas de un programa, política o intervención?
-Las evaluaciones económicas se realizan una vez que un programa, política o intervención ha demostrado su eficacia, pero antes de su implementación y difusión a gran escala.
¿Cómo se compara un análisis de costo-beneficio con un análisis de costo-efectividad?
-Mientras que un análisis de costo-beneficio convierte los resultados en dólares, un análisis de costo-efectividad expresa los resultados en unidades naturales de salud, como el número de casos de enfermedad cardiovascular evitados o las vidas salvadas.
¿Por qué se deben realizar análisis de costo-efectividad con intervenciones que afectan el mismo resultado de salud?
-Se deben realizar análisis de costo-efectividad con intervenciones que afectan el mismo resultado de salud para asegurar la comparabilidad de los resultados y para facilitar la toma de decisiones sobre la asignación eficiente de recursos.
¿Qué es la medida resumen en un análisis de costo-efectividad?
-La medida resumen en un análisis de costo-efectividad es la relación entre los costos netos del programa divididos por los efectos del programa netos.
¿Cómo se definen los efectos en un análisis de costo-efectividad?
-Los efectos en un análisis de costo-efectividad pueden definirse de manera estrecha o amplia. Las definiciones estrechas incluyen efectos intermediarios, mientras que las definiciones amplias son los efectos finales y más alejados, como casos de enfermedad del corazón evitados, vidas salvadas o años de vida ganados.
¿Qué es un año de vida ajustado por calidad (QALY) y cómo se relaciona con el análisis de costo-utilidad?
-Un año de vida ajustado por calidad (QALY) es una medida que combina la duración de la vida y la calidad de vida, donde la calidad de vida es ajustada según el estado de salud. Se utiliza en análisis de costo-utilidad para comparar intervenciones que afectan diferentes resultados de salud.
¿Cómo se aborda el problema de múltiples resultados en un análisis de costo-efectividad?
-Para abordar el problema de múltiples resultados, se puede realizar un análisis de costo-utilidad, donde los resultados se expresan como un índice de salud que combina todos los resultados de salud asociados con una intervención en términos de aumentos en la duración de la vida y la calidad de vida.
¿Qué son las utilidades y cómo se relacionan con el análisis de costo-efectividad?
-Las utilidades son una forma de describir cuantitativamente las preferencias del consumidor por una buena calidad de vida y son una medida subjetiva de la utilidad resultante de estar en diferentes estados de salud. Se utilizan para cuantificar los beneficios en un análisis de costo-efectividad, es decir, para derivar un año de vida ajustado por calidad (QALY).
¿Qué son las DALY (Años de Vida Ajustados por Discapacidad) y cómo se relacionan con el análisis de costo-efectividad?
-Los Años de Vida Ajustados por Discapacidad (DALY) son una medida utilizada en análisis de costo-efectividad para medir la carga de la enfermedad y lesiones, y para permitir estimaciones comparables de estas cargas a nivel internacional. Se derivan de las estimaciones de años de vida perdidos y años de vida vividos con una discapacidad.
¿Cómo se determinan los umbrales para lo que se considera cost-effective en un análisis de costo-efectividad?
-Los umbrales para lo que se considera cost-effective se determinan a menudo comparando las relaciones de costo-efectividad con las publicadas en la literatura o con las relaciones para intervenciones que se consideran como prácticas aceptadas. Aunque hay algunos umbrales arbitrarios establecidos, hay controversia sobre estos umbrales, especialmente porque no se han ajustado por inflación.
¿Por qué es importante la evaluación económica para la formulación de políticas de salud pública?
-La evaluación económica es valiosa para la toma de decisiones y la configuración de políticas de salud, ya que puede ayudar a priorizar recursos para las estrategias más efectivas. Asume la evidencia y las decisiones basadas en la evidencia, y es un componente importante de la evaluación de programas en salud pública y prevención que debe ser considerado debido al crecimiento de la demanda de estas evaluaciones.
Outlines
💼 Costo-efectividad en la evaluación económica
El primer párrafo aborda el análisis de coste-efectividad, una forma de evaluación económica que se realiza una vez que un programa, política o intervención ha demostrado su eficacia y antes de su implementación masiva. Se menciona que, aunque generalmente se realiza retrospectivamente, a veces se realiza de manera prospectiva junto a ensayos clínicos o comunitarios. La comparación de costos con resultados se realiza en unidades de salud naturales, no en dólares. Se destaca la necesidad de comparar intervenciones que afecten el mismo resultado de salud, como programas para prevenir la obesidad. Se introduce la medida de resumen del análisis de coste-efectividad como la relación entre los costos netos del programa y sus efectos netos. Además, se discute la consideración de efectos estrechos y amplios, y la importancia de los efectos finales en la formulación de políticas públicas. Se señala la limitación de no poder combinar resultados en unidades naturales y se sugiere el análisis de coste-utilidad para abordar múltiples resultados de salud.
📊 Análisis de coste-utilidad y medidas de salud
El segundo párrafo profundiza en el análisis de coste-utilidad, que midiendo los resultados en años de vida ajustados por calidad (AVAQ), permite comparar intervenciones que afectan diferentes resultados de salud. Se describe cómo se calculan los AVAQ, considerando tanto la duración de la vida como la calidad de vida. Se exploran diferentes métodos para obtener las utilidades o ponderaciones de preferencia, como el método del riesgo estándar y el intercambio de tiempo, así como la escala de rating. Se discute la elección entre el uso de pesos de preferencia publicados y la utilización de herramientas de evocación indirecta, y se señalan las ventajas y desventajas de cada enfoque. Además, se menciona cómo se interpretan los resultados de estas evaluaciones en términos de expectativa de vida ajustada por calidad.
📉 Análisis de coste-efectividad del programa WISEWOMAN
El tercer párrafo presenta un ejemplo de análisis de coste-efectividad del programa WISEWOMAN, que busca reducir el riesgo de enfermedad cardiovascular. Se traduce el rendimiento del programa en reducción del riesgo de enfermedad cardiovascular a años de vida ganados y se evalúa la incertidumbre de la duración de dichos cambios en la vida. Se describe cómo se calcula el costo promedio por año de vida ganado y cómo varía este costo bajo diferentes suposiciones sobre la duración de los cambios en el riesgo de enfermedad. Se destaca la importancia de tener en cuenta los resultados a largo plazo en el análisis de coste-efectividad.
💭 Umbrales de coste-efectividad y decisiones políticas
El cuarto párrafo discute la determinación de los umbrales de coste-efectividad y cómo los tomadores de decisiones deben establecer el punto en el que una intervención es considerada rentable. Se mencionan algunos umbrales arbitrarios establecidos en Estados Unidos y el Reino Unido y se señala la controversia en torno a estos umbrales. Se sugiere la comparación con ratios de coste-efectividad publicados en la literatura o con ratios de intervenciones ampliamente aceptadas como práctica. Se proporciona un ejemplo de análisis que evalúa el potencial coste-efectividad del tratamiento de pacientes con hipertensión según nuevas pautas de 2014. Además, se aborda la diferencia en la aplicación de los estándares de coste-efectividad en el ámbito clínico y en el ámbito de la prevención y la salud pública.
🌐 Años de vida ajustados por discapacidad (DALY)
El quinto y último párrafo concluye con la importancia del análisis económico en la toma de decisiones y la formulación de políticas de salud. Se destaca que el análisis económico es una combinación de arte y ciencia que ayuda a priorizar recursos para las estrategias más efectivas. Se menciona el uso de los años de vida ajustados por discapacidad (DALY) como medida de resultados en el análisis de coste-utilidad, y se describe cómo se calculan a partir de la estimación de años de vida perdidos y años vividos con discapacidad. Se proporciona una lista de las diez principales categorías de enfermedades que contribuyen a los DALY en los Estados Unidos para el año 2010, destacando la alta posición de las enfermedades cardiovasculares y los trastornos neuropsiquiátricos en la lista.
Mindmap
Keywords
💡cost-effectiveness analysis
💡benefit-cost analysis
💡net programmatic costs
💡quality-adjusted life year (QALY)
💡disability-adjusted life year (DALY)
💡incremental cost-effectiveness ratio (ICER)
💡standard gamble approach
💡time trade-off method
💡rating scale
💡preference weights
💡long-term outcomes
Highlights
Cost-effectiveness analysis is a type of economic evaluation used to compare the costs and outcomes of different health interventions
It is conducted retrospectively after a program is proven effective, but before widespread implementation
Cost-effectiveness analysis compares costs to outcomes in natural health units, unlike benefit-cost analysis which converts outcomes to dollars
Interventions or programs being compared must impact the same health outcome
The summary measure is the ratio of net programmatic costs to net program effects
Programmatic costs are calculated as program costs minus the cost of illness averted
Cost-effectiveness ratios can be calculated as average or incremental
Outcomes can be defined narrowly (intermediate effects) or broadly (final effects like cases prevented or lives saved)
Broadly defined effects are preferred for public policy decisions
A major limitation is outcomes in natural units cannot be combined and must be considered separately
Cost-utility analysis can deal with multiple health outcomes by expressing them as a health index
Quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs) are used as summary measures in cost-utility analysis
Utilities or preference weights are used to quantify the impact of health states on quality of life
Utilities are measured on a 0-to-1 scale where 0 is death and 1 is perfect health
There are various methods to directly elicit utilities, such as standard gamble, time trade-off, and rating scale
Indirect elicitation tools like the EuroQol 5D scale can also be used to derive utilities
The choice of threshold values to determine cost-effectiveness is subjective and varies by country and context
Disability-adjusted life years (DALYs) measure disease burden by combining years of life lost and years lived with disability
Economic evaluation is valuable for decision-making and setting health policy, assuming evidence-based decisions
Transcripts
[NARRATOR] The last module discusses another type of economic
evaluation: cost-effectiveness analysis. As discussed in the benefit-cost analysis module, economic evaluations
are best conducted once a program, policy, or intervention has proven effective but prior to widespread
implementation and dissemination.
In this way, economic evaluations are typically conducted retrospectively.
However, an economic evaluation is often conducted prospectively, alongside community or
clinical trials to ensure efficient allocation of scarce public health resources.
As with benefit-cost analysis, a cost-effectiveness analysis compares an intervention’s costs
to its outcomes.
Unlike a benefit-cost analysis, a cost-effectiveness analysis expresses outcomes in natural health
units, such as the number of cardiovascular disease cases prevented or the number of lives
saved, instead of converting outcomes to dollars.
Because of this major difference, cost-effectiveness analysis must be conducted with interventions
or programs that impact the same health outcome.
For example, you could compare two programs designed to prevent overweight or obesity,
where one program focuses on physical activity and the other focuses on nutrition.
The summary measure in cost-effectiveness analysis is the ratio of net programmatic
costs divided by net program effects.
Programmatic costs are program costs minus the cost of illness averted by the program.
Cost-effectiveness ratios can be an average.
One intervention at a time is assessed in terms of net costs divided by net effects.
Two or more programs affecting the same health outcome can be compared in terms of incremental
net costs of one program compared to another, divided by incremental net effects of one
program compared to another.
Outcomes or effects included in cost-effectiveness analysis can be defined narrowly or broadly,
although broad definitions are preferred for decisions bearing on public policy.
Narrowly defined effects include those that are intermediate in nature and that may be
easier to capture, such as immediate increases in physical activity or decreases in blood
pressure associated with a hypertension intervention.
Broadly defined effects are those that are more final and further removed, such as cases
of heart disease prevented, lives saved, or years of life gained.
These broad outcomes are more appealing in terms of effectiveness goals for a hypertension intervention.
However, you may only have intermediate outcomes to work with unless you can follow intervention
participants over time or find good epidemiologic evidence linking intermediate to final outcomes.
A major caveat in conducting cost-effectiveness analysis is that outcomes in natural units
cannot be combined and must be considered separately.
For example, a physical activity program may have two intended effects: lowering blood
pressure and decreasing body mass index.
Because these two effects can’t be combined in a cost-effectiveness analysis, the summary
measure for the analysis would be cost per 1 percent reduction in blood pressure and
cost per 1 percent decrease in body mass index.
However, the cost in these two summary measures is the same, so the ratios are somewhat misleading.
This makes cost-effectiveness ratios using natural units difficult for policy-makers
to translate.
One method for dealing with the problem of multiple outcomes, particularly if there are
multiple health outcomes, is to conduct a cost-utility analysis.
In this type of analysis, outcomes are expressed as a health index.
This combines all health outcomes associated with an intervention in terms of increases
in length of life and quality of life.
Length of life adjusted by quality of life is known as a quality-adjusted life year,
sometimes referred to as a disability-adjusted life year.
In a cost-utility analysis, you could compare interventions that affect different health
outcomes by using a quality-adjusted life year—for example, when comparing interventions
that affect obesity, nutritional outcomes, and cardiovascular disease.
The summary measure in a cost-utility analysis is cost per quality-adjusted life year or
cost per disability-adjusted life year.
Cost-utility analysis is used when quality of life, rather than length of life, is the
most important effect of the intervention.
For example, a cost-utility analysis of a cardiac rehabilitation program might focus
on improved quality of life versus the cardiac rehab’s influence on the length of life.
Cost-utility analysis is also used when the program affects both morbidity and mortality outcomes.
An example is emergency medical services’ pre-hospital stroke care, which has long-term
effects on recovery and disability.
Cost-utility analysis can be used when comparing interventions that affect different health
outcomes, like cancer versus cardiovascular disease prevention.
Finally, cost-utility analysis should be used when comparing results to other studies that
also employ cost-utility analysis as the economic evaluation methodology.
Utilities, or preference weights, are a way to quantitatively describe consumer preferences
for good quality of life and a subjective measure of the usefulness that results from
being in different health states.
Because utilities are quantitative, they are measurable and analyzable.
They’re typically based on a 0-to-1 scale, where 0 is considered death and 1 is considered
perfect health.
To quantify benefits in a cost-utility analysis— that is, to derive a quality-adjusted life year—you
need to know the intervention’s effect on length of life and quality of life.
Data on length of life may be readily accessible from epidemiologic literature.
Effects on quality of life, however, are theoretically derived from individuals directly as their
preference weights, or utilities, for the health state under consideration.
For example, what is the preference for having a body mass index above 35 versus having one
between 25 and 35?
There are a number of ways to directly elicit utilities.
There are methods that rely on a specific response method, such as scale versus choice,
and methods that rely on a specific type of questioning format, such as asking about certain
events versus uncertain events.
Theoretically, to be considered an economic “utility,” the response method must be
a choice and the questioning format must include an uncertainty.
Therefore, the only correct way to derive utilities for health states is the standard
gamble approach, although other approaches are popular in the literature.
The standard gamble approach is based on the conceptual framework for examining decisions
under uncertainty.
The respondent is given a choice between a less-than-optimal health state— for example,
having a body mass index above 35—and a lottery between two uncertain health states.
The two uncertain health states are often perfect health and death and can be valued
as 1 and 0, respectively.
The two uncertain health states don’t have to include perfect health and death.
The only requirement is that the certain health state be in between the two outcomes associated
with the gamble.
In this setup, the respondent is asked something like this: Imagine you have a body mass index
above 35, with no other adverse health outcomes.
Now suppose there’s a surgery available to you that would reduce your body mass index
to a perfect level, thus giving you perfect health.
However, there’s a probability of death associated with the surgery.
How low does the probability of death have to be for you to be indifferent between your
certain health, with a body mass index above 35, and the gamble of taking the surgery,
which could lead to death or perfect health?
The probability, or p value, derived from this scenario reflects the utility for the
certain health state under consideration— in this case, body mass index above 35.
Another way to directly elicit utilities is the time trade-off method, which was developed
as an alternative to the standard gamble.
This method is used primarily in health research.
The respondent is offered a choice between two alternatives of certainty.
The goal is to find the point where the person becomes indifferent between the two alternatives.
Here’s the setup: Imagine that your remaining life expectancy is 20 years and you have severe angina.
How much of your remaining life expectancy would you give up to eliminate your severe
angina so that you have perfect health?
The number of years you would give up, divided by the remaining life expectancy and subtracted
from 1, represents the utility associated with severe angina.
Finally, the rating scale is the most common approach to directly eliciting utilities.
This involves ranking alternatives and then placing them on an ordinal scale.
For example, alternatives might include perfect health, mild angina, severe angina, and death.
This example uses a visual analog scale, which is typically horizontal.
There are a couple of advantages of this approach.
The cognitive burden is lower than with other techniques, and people are familiar with the technique.
There are several disadvantages, however.
First is the anchoring effect.
What is set as the best possible state and the worst possible state is subjective, creating
an indexing problem.
In addition, we can’t make any interpretations about the numbers themselves, such as 88 versus
60, because of the ordinal scale.
Furthermore, people have an aversion to the ends of the scale, so they treat the middle
of the scale as one scale and the ends of the scale as another scale.
There are also context effects.
Ranking and scoring depend not just on the states themselves, but also on the states
being compared.
Finally, this approach is based on conditions of certainty and not really tied to utilities
or the theoretical foundation on which cost-effectiveness analysis is based.
In addition to directly eliciting utilities, there are published preference weights in
the literature from individual studies.
Compendia of weights are available online at the Tufts Medical Center Web site.
The disadvantage of using weights derived from other studies is comparability.
It could be that weights are derived from different populations, for slightly different
health outcomes, et cetera.
As an alternative, there are widely available, indirect elicitation tools that involve people
classifying their health states based on a number of health domains—such as physical
functioning, role, social, and emotional—then applying directly elicited preference weights.
Many such tools are available, sometimes for a small fee.
The disadvantages of these tools are that their weights may be derived from dissimilar
populations, they may not have included the same health outcome you are considering, and
they may not have included the same severity levels.
The direct measures we discussed should be elicited from general populations, but expert
panels or special disease-specific samples are often used.
Major disadvantages are costs, time to collect, and representativeness outside your study.
Here’s an example of an indirect utility elicitation tool using the EuroQol 5 dimension
scale included in the Medical Expenditure Panel Survey for a few years in the early 2000s.
Examples of decreases in utilities, or disutilities, are shown for a number of chronic diseases.
Here’s how you can interpret these results: Imagine a person with chronic hypertension,
with a remaining life expectancy of 20 years.
You could say that the person has a quality-adjusted life expectancy of 19 years and 6 months—
or a loss of 6 months in quality-adjusted life expectancy.
This is derived by multiplying .025 by life expectancy to get .5 years, or 6 months.
Once the utilities are determined for the effects of the intervention, you can compare
the difference in quality of life and length of life between the intervention and no intervention
in this example.
Here’s an example of a cost-effectiveness analysis of the WISEWOMAN program.
The unit of effectiveness was reduction in cardiovascular disease risk, which was then
translated, based on epidemiologic evidence in the literature, to life years gained.
The uncertainty in the analysis was how long the changes in the cardiovascular disease
risk were assumed to last, thus affecting life years saved and costs per life years saved.
The program was assessed in relation to itself, not compared to other interventions, which
produced an assessment of the average cost-effectiveness ratio.
As a result, the authors found that the program cost 4,400 dollars per life year gained under
the most optimal assumptions, which would be changes in cardiovascular disease risk
assumed to last a lifetime.
But when more realistic, longer-term outcomes were evaluated, the costs increased to 15,300
dollars per life year saved.
These changes in cardiovascular disease risk were assumed to last for the lifetime of only
24 percent of the participants.
Costs were more than 133,000 dollars per life year saved when the cardiovascular disease
risk changes were assumed to last only one year and not longer.
This study shows the importance of having longer-term, final outcomes in the cost-effectiveness analysis.
Unlike in benefit-cost analysis, where the summary measures are objective, cost-effectiveness
analysis results in a subjective summary measure.
The policy-maker must still determine the threshold below which an intervention is considered
cost-effective and above which an intervention is not considered cost-effective.
Some arbitrary thresholds have been set in both the United States and the United Kingdom,
but there is still some controversy about these thresholds, particularly because the
cost-effectiveness ratios haven’t been adjusted for inflation.
One way to determine threshold values is to compare cost-effectiveness ratios to ratios
published in the literature or to ratios for interventions that are commonly accepted as
good practice.
Here is an example from a study analyzing the potential cost effectiveness of treating
all hypertension patients according to new 2014 guidelines, with CE ratios for each of
the different patient groups.
As you can see, the authors have defined what they consider cost-effective for this study
and ranked each group according to these defined cut-offs.
In this case, less than 50,000 dollars per QALY was considered cost effective, which
is a commonly used threshold in the literature.
We might think of the cost-effectiveness ratio on a continuum but without an actual rule
for policy-making.
There are some ranges within which an intervention is clearly a good value, and other ranges
within which an intervention is clearly not.
It’s the intermediate cost-effectiveness ratios that require some subjectivity on the
part of policy-makers.
Furthermore, a different set of standards seems to apply to policy-making in the treatment
or clinical world compared to the prevention or population-based health world.
But this discrepancy is due in part to the newness of economic evaluations to prevention
and public health.
Much of the acceptance of economic evaluations for informing policy-making and standardizing
practices comes from education modules like this that introduce the concepts to the field.
Much has been done in public health since the early 1990s, but there’s still
a long way to go.
Grosse and colleagues wrote a paper which specifically discussed the use of economic
evaluations to inform public policy.
The authors found no consistent use of economic evaluations to inform public policy in the
United States.
The same cannot be said in the United Kingdom, where economic evaluations are part of how
the National Health Service determines which benefits are covered.
The authors also found many missed opportunities and no clear thresholds for cost-effectiveness
analysis in whatever policies were informed by economic evaluations.
Disability-adjusted life years are another outcome measure that can be used in cost-utility analysis.
Disability-adjusted life years were developed in the international community primarily to
measure disease and injury burden and to allow comparable estimates of these burden measures
across countries.
The disability-adjusted life year weights are slightly different from the quality-adjusted
life year weights, with an inverted scale of 0 referring to perfect health, or no disabilities,
and 1 referring to death, or 100 percent disabled.
Disability-adjusted life years are derived from the estimates of years of life lost—which
is a common metric to measure burden of disease internationally—and years of life lived
with a disability.
It’s essentially the same thing as quality-adjusted life years in that life expectancy, in life
years, is adjusted for the number of years living with a disability.
Disability-adjusted life year weights are derived differently than quality-adjusted
life year weights.
Instead of using the standard gamble, time trade-off, or rating scale approaches with
a general population sample, experts are asked to trade off numbers of people to keep alive
with certain conditions.
Here are the top ten disease categories contributing to DALYs in the U.S. from 2010.
As would be expected, CVD is near the top because of the high number of years of life
lost, as well as the decreased quality of life it can cause for people living with the disease.
But even above CVD is neuropsychiatric disorders; although these disorders don’t contribute
much to years of life lost from a disease, the high number of years of life lived with
the disorders and the decreased quality of life they cause pushes them to the top
contributor of DALYs.
In conclusion, economic evaluation is valuable to decision-making and in setting health policy.
Economic evaluation is both art and science, and it can be used to help prioritize resources
for the most effective strategies.
It assumes evidence and evidence-based decisions.
For researchers in public health and prevention, this is an important component of program
evaluation that should be considered because the demand for these evaluations is growing.
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