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Asymmetries of poverty: why global burden of disease valuations underestimate the burden of neglected tropical diseases.

King CH, Bertino AM - PLoS Negl Trop Dis (2008)

Bottom Line: It was originally thought that the DALY would be useful in policy settings, reflecting normative valuations as a standardized unit of ill health.The conceptual design of the DALY comes out of a perspective largely focused on the individual risk rather than the ecology of disease, thus failing to acknowledge the implications of context on the burden of disease for the poor.The present DALY framework needs to be substantially revised if the GBD is to become a valid and useful system for determining health priorities.

View Article: PubMed Central - PubMed

Affiliation: Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. chk@cwru.edu

ABSTRACT
The disability-adjusted life year (DALY) initially appeared attractive as a health metric in the Global Burden of Disease (GBD) program, as it purports to be a comprehensive health assessment that encompassed premature mortality, morbidity, impairment, and disability. It was originally thought that the DALY would be useful in policy settings, reflecting normative valuations as a standardized unit of ill health. However, the design of the DALY and its use in policy estimates contain inherent flaws that result in systematic undervaluation of the importance of chronic diseases, such as many of the neglected tropical diseases (NTDs), in world health. The conceptual design of the DALY comes out of a perspective largely focused on the individual risk rather than the ecology of disease, thus failing to acknowledge the implications of context on the burden of disease for the poor. It is nonrepresentative of the impact of poverty on disability, which results in the significant underestimation of disability weights for chronic diseases such as the NTDs. Finally, the application of the DALY in policy estimates does not account for the nonlinear effects of poverty in the cost-utility analysis of disease control, effectively discounting the utility of comprehensively treating NTDs. The present DALY framework needs to be substantially revised if the GBD is to become a valid and useful system for determining health priorities.

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Related in: MedlinePlus

The DALY Person-Trade-Off Method of Disability Weight Determination.
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pntd-0000209-g001: The DALY Person-Trade-Off Method of Disability Weight Determination.

Mentions: DWs for the DALY system were determined by panels of nonexpert, highly educated participants assembled during the initial GBD programs of the late 1980s and early 1990s [9]. Their DW scores were assigned using an established (and, some might argue, nonintuitive [22]) health economics technique called the “person trade-off” (PTO) method (Box 4). The group's choices were benchmarked against a ladder of 22 indicator conditions that had been previously ranked by the same group or by other nonexpert groups (Figure 1). In assigning DWs, capsule scenarios of each disease state were provided to the PTO groups in order to guide their discussions. Where the group's choices disagreed, particularly between the two PTO methods, a group leader or facilitator required them to come to a consensus score for each condition. The resulting single point estimate for the DW is expressed on a scale from 0 to 1, where 0 denotes perfect health and 1 is death [9].


Asymmetries of poverty: why global burden of disease valuations underestimate the burden of neglected tropical diseases.

King CH, Bertino AM - PLoS Negl Trop Dis (2008)

The DALY Person-Trade-Off Method of Disability Weight Determination.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2267491&req=5

pntd-0000209-g001: The DALY Person-Trade-Off Method of Disability Weight Determination.
Mentions: DWs for the DALY system were determined by panels of nonexpert, highly educated participants assembled during the initial GBD programs of the late 1980s and early 1990s [9]. Their DW scores were assigned using an established (and, some might argue, nonintuitive [22]) health economics technique called the “person trade-off” (PTO) method (Box 4). The group's choices were benchmarked against a ladder of 22 indicator conditions that had been previously ranked by the same group or by other nonexpert groups (Figure 1). In assigning DWs, capsule scenarios of each disease state were provided to the PTO groups in order to guide their discussions. Where the group's choices disagreed, particularly between the two PTO methods, a group leader or facilitator required them to come to a consensus score for each condition. The resulting single point estimate for the DW is expressed on a scale from 0 to 1, where 0 denotes perfect health and 1 is death [9].

Bottom Line: It was originally thought that the DALY would be useful in policy settings, reflecting normative valuations as a standardized unit of ill health.The conceptual design of the DALY comes out of a perspective largely focused on the individual risk rather than the ecology of disease, thus failing to acknowledge the implications of context on the burden of disease for the poor.The present DALY framework needs to be substantially revised if the GBD is to become a valid and useful system for determining health priorities.

View Article: PubMed Central - PubMed

Affiliation: Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. chk@cwru.edu

ABSTRACT
The disability-adjusted life year (DALY) initially appeared attractive as a health metric in the Global Burden of Disease (GBD) program, as it purports to be a comprehensive health assessment that encompassed premature mortality, morbidity, impairment, and disability. It was originally thought that the DALY would be useful in policy settings, reflecting normative valuations as a standardized unit of ill health. However, the design of the DALY and its use in policy estimates contain inherent flaws that result in systematic undervaluation of the importance of chronic diseases, such as many of the neglected tropical diseases (NTDs), in world health. The conceptual design of the DALY comes out of a perspective largely focused on the individual risk rather than the ecology of disease, thus failing to acknowledge the implications of context on the burden of disease for the poor. It is nonrepresentative of the impact of poverty on disability, which results in the significant underestimation of disability weights for chronic diseases such as the NTDs. Finally, the application of the DALY in policy estimates does not account for the nonlinear effects of poverty in the cost-utility analysis of disease control, effectively discounting the utility of comprehensively treating NTDs. The present DALY framework needs to be substantially revised if the GBD is to become a valid and useful system for determining health priorities.

Show MeSH
Related in: MedlinePlus