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Gains in QALYs vs DALYs averted: the troubling implications of using residual life expectancy

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This note explores the difference between QALYs gained and DALYs averted in estimates of health benefits from interventions, where DALYs are estimated using local life expectancy tables. I assume that disability weights in the DALYs framework correspond to quality adjustment weights in QALYs, that there is no age weighting and that both frameworks use the same discounting methodology. I find that for the same intervention, health benefit measured as a reduction in DALYs is always smaller than the same benefit measured as a gain in QALYs. The higher the age of deaths prevented by the intervention, and the lower the quality of life in the years of life gained, the bigger the difference between DALYs and QALYs. The difference is reduced when benefits are discounted. I show that the difference can lead to a different ranking in cost-effectiveness league tables based on DALYs averted compared to gains in QALYs. I conclude that the use of the DALY framework based on local life expectancy tables might be appropriate for estimating the total burden of disease, but leads to troubling results if used for cost-effectiveness analysis. The use of a fixed reference age would avoid those implications, but might not be a reasonable assumption for estimating the total burden of disease.

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en

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application/pdf

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http://eprints.lse.ac.uk/28789/1/LSEHWP8.pdf

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