Disability-adjusted life years: a critical review

Area of Science:

• Public Health
• Health Economics
• Epidemiology

Background:

• The disability-adjusted life year (DALY) is increasingly used in global health policy to quantify disease burden.
• Concerns exist regarding the methodological rigor and ethical implications of DALY calculations.

Purpose of the Study:

• To critically evaluate the conceptual and technical foundations of the DALY measure.
• To examine the validity of DALYs for both disease burden assessment and resource allocation.

Main Methods:

• Conceptual analysis of DALY methodology.
• Ethical and economic critique of DALY assumptions, including age-weighting and discounting.
• Distinction between disease burden measurement and resource allocation frameworks.

Main Results:

• The conceptual and technical basis of DALYs is found to be flawed.
• Age-weighting and discounting present unacceptable ethical and practical challenges.
• Using DALYs for resource allocation, specifically aggregate DALY-minimization, leads to inequitable outcomes.

Conclusions:

• DALYs possess significant limitations that undermine their reliability as a measure of disease burden.
• The application of DALYs in resource allocation is ethically problematic and inequitable.
• A clearer distinction is needed between disease burden metrics and resource allocation tools.