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Can the value choices in DALYs influence global priority-setting?

Trude Arnesen¹, Lydia Kapiriri

¹Fafo Institute of Applied International Studies, P.O. Box 2947, Tøyen, NO-0608 Oslo, Norway. tma@fafo.no

Health Policy (Amsterdam, Netherlands)

|September 15, 2004

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Disability Adjusted Life Years (DALYs) calculations are sensitive to value choices, potentially inverting disease burden rankings. Transparency issues hinder accurate assessment, suggesting separate reporting of years lost and lived with disease.

Area of Science:

Global Health
Epidemiology
Health Economics

Background:

Disability Adjusted Life Years (DALYs) are a key metric for the Global Burden of Disease, integrating mortality and morbidity.
DALY calculations involve subjective value choices like disability weighting, age-weighting, and discounting, affecting life year valuation.
The robustness and transparency of these value choices in DALY calculations are critical for accurate health decision-making.

Purpose of the Study:

To assess the sensitivity of DALY distribution to changes in value choices.
To evaluate the transparency of DALY calculations at the point of use.
To propose a more transparent approach for reporting disease burden.

Main Methods:

Sensitivity analysis was performed on DALY calculations for "developmental disability due to malnutrition" and "major depression" using alternative value choices.

Related Experiment Videos

Data on formulae and value choices were sourced from World Health Organisation (WHO) publications and a survey of international health workers.

Explored the relationship between disability weight, health state description, and incidence rate.

Main Results:

Alternative age-weights, disability weights, and discount rates led to an inversion in the burden ranking of the two studied conditions.
DALY loss for "developmental disability due to malnutrition" increased from 14% to 90%, while "major depression" decreased from 86% to 10%.
Current value choices may underestimate the burden of diseases prevalent in younger populations and low-income countries.

Conclusions:

DALY calculations are highly sensitive to underlying value choices, impacting disease burden comparisons.
Lack of transparency in DALYs prevents users from understanding the specific components contributing to the calculated burden.
A more transparent method would involve separately reporting "years lost" and "years lived with disability" without subjective weighting or discounting.