[Towards an effective assessment of the sustainability of health interventions]

In a sluggish economy, cost containment is a central issue for the national health service, and health authorities are increasingly requiring proof of the economic and clinical value of health interventions. In this context, the integration and/or evolution of techniques to measure the economic sustain- ability of new technologies is essential. The disability-adjusted life year (DALY) and quality-adjusted life year (QALY) are two measures used in the assessment of health interventions, which, although based on the same theoretical concept, differ in a number of important aspects. DALY can overcome the limit of using arbitrary economic threshold values since it is a benchmark directly comparable with the GDP per capita, an unbiased measure of sustainability. Indeed, in 2002 the World Health Organization (WHO) suggested that interventions costing less than 3 times the per-capita GDP per DALY averted could be considered cost effective. The Expected Value of Information and an estimate of the contribution to GDP (social costs due to presenteeism and absenteeism), along with Health Technology Assessment-based disinvestment decisions and the generation of a comprehensive health dataset (to be analysed using artificial intelligence) should be implemented. These procedures may improve the effectiveness of health governance and lead to better quality of healthcare services.