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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: 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.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.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

In the Context of Poverty There Are Nonlinear Differences in the Efficacy of Treatment on Health Outcomes.Individual poverty and residence in an impoverished environment can combine synergistically to impair improvement from single health interventions. (See reference [56].)
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pntd-0000209-g003: In the Context of Poverty There Are Nonlinear Differences in the Efficacy of Treatment on Health Outcomes.Individual poverty and residence in an impoverished environment can combine synergistically to impair improvement from single health interventions. (See reference [56].)

Mentions: D. Due to nonlinear quantitative factors, common cost-effectiveness evaluations may fail to be relevant in the setting of the “poverty trap” [56]. In standard cost-effectiveness analysis (CEA), there is a tacit assumption of linearity between the size of health-care investment and the size of health benefits obtained (Figure 3) [57]. As DALYs are frequently used as outcomes or “utilities” in this type of exercise, a traditional CEA will prove invalid for NTDs for two reasons: first, because of misclassification of the nature and size of disease burden (DW), and second, because of the nonlinear effects of poverty on reversibility of disease burden.


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)

In the Context of Poverty There Are Nonlinear Differences in the Efficacy of Treatment on Health Outcomes.Individual poverty and residence in an impoverished environment can combine synergistically to impair improvement from single health interventions. (See reference [56].)
© Copyright Policy
Related In: Results  -  Collection

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

pntd-0000209-g003: In the Context of Poverty There Are Nonlinear Differences in the Efficacy of Treatment on Health Outcomes.Individual poverty and residence in an impoverished environment can combine synergistically to impair improvement from single health interventions. (See reference [56].)
Mentions: D. Due to nonlinear quantitative factors, common cost-effectiveness evaluations may fail to be relevant in the setting of the “poverty trap” [56]. In standard cost-effectiveness analysis (CEA), there is a tacit assumption of linearity between the size of health-care investment and the size of health benefits obtained (Figure 3) [57]. As DALYs are frequently used as outcomes or “utilities” in this type of exercise, a traditional CEA will prove invalid for NTDs for two reasons: first, because of misclassification of the nature and size of disease burden (DW), and second, because of the nonlinear effects of poverty on reversibility of disease burden.

Bottom Line: 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.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.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