The evolution of the disability-adjusted life year (DALY)

Chen, Ariel; Jacobsen, Kathryn H.; Deshmukh, Ashish A.; Cantor, Scott B.

doi:10.1016/j.seps.2014.12.002

Cited by 68 publications

(52 citation statements)

References 34 publications

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“…The analyses use Global Burden of Disease study data, which are themselves modelled estimates and will on occasions be based on imputations due to missing data, and have been subject to criticism. 33 Selection of timepoints for research investments and disease burden will affect our findings as both of these change over time.…”

Section: Discussionmentioning

confidence: 99%

The allocation of US$105 billion in global funding from G20 countries for infectious disease research between 2000 and 2017: a content analysis of investments

Head

Brown

Newell

et al. 2020

The Lancet Global Health

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Background Each year, billions of US$ are spent globally on infectious disease research and development. However, there is little systematic tracking of global research and development. We present research on investments into infectious diseases research from funders in the G20 countries across an 18-year time period spanning 2000–17, comparing amounts invested for different conditions and considering the global burden of disease to identify potential areas of relative underfunding. Methods The study examined research awards made between 2000 and 2017 for infectious disease research from G20-based public and philanthropic funders. We searched research databases using a range of keywords, and open access data were extracted from funder websites. Awards were categorised by type of science, specialty, and disease or pathogen. Data collected included study title, abstract, award amount, funder, and year. We used descriptive statistics and Spearman's correlation coefficient to investigate the association between research investment and disease burden, using Global Burden of Disease 2017 study data. Findings The final 2000–17 dataset included 94 074 awards for infectious disease research, with a sum investment of $104·9 billion (annual range 4·1 billion to 8·4 billion) and a median award size of $257 176 (IQR 62 562–770 661). Pre-clinical research received $61·1 billion (58·2%) across 70 337 (74·8%) awards and public health research received $29·5 billion (28·1%) from 19 197 (20·4%) awards. HIV/AIDS received $42·1 billion (40·1%), tuberculosis received $7·0 billion (6·7%), malaria received $5·6 billion (5·3%), and pneumonia received $3·5 billion (3·3%). Funding for Ebola virus ($1·2 billion), Zika virus ($0·3 billion), influenza ($4·4 billion), and coronavirus ($0·5 billion) was typically highest soon after a high-profile outbreak. There was a general increase in year-on-year investment in infectious disease research between 2000 and 2006, with a decline between 2007 and 2017. Funders based in the USA provided $81·6 billion (77·8%). Based on funding per 2017 disability-adjusted life years (DALYs), HIV/AIDS received the greatest relative investment ($772 per DALY), compared with tuberculosis ($156 per DALY), malaria ($125 per DALY), and pneumonia ($33 per DALY). Syphilis and scabies received the least relative investment (both $9 per DALY). We observed weak positive correlation (r=0·30) between investment and 2017 disease burden. Interpretation HIV research received the highest amount of investment relative to DALY burden. Scabies and syphilis received the lowest relative funding. Investments for high-threat pathogens (eg, Ebola virus and coronavirus) were often reactive and followed outbreaks. We found little evidence that funding is proactively guided by global burden or pandemic risk. Our findings show how research investments are allocated and how this relates to disease burden and diseases with pandemic potentia...

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Section: Discussionmentioning

confidence: 99%

The allocation of US$105 billion in global funding from G20 countries for infectious disease research between 2000 and 2017: a content analysis of investments

Head

Brown

Newell

et al. 2020

The Lancet Global Health

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“…The value of a health state is determined by their 'disability weight'; this weight was estimated using a household survey in five countries and an open-access online survey, where paired comparison questions asked participants to indicate which of two health scenarios represented a greater level of overall health (Salomon et al, 2013). The notion of disability describes the impact of impairment on health, and the weights reflect how affected a person's health would be with respect to the given disability; the specific focus is 'health loss' rather than 'welfare loss', where the former focuses on changes in wellbeing due to physical and mental health, while the latter could include such factors as social considerations that alter wellbeing (Chen et al, 2015). With respect to public health interventions and health promotion programmes with broad outcomes, DALYs do not offer a measure of quality of life beyond health/disability.…”

Section: Value Positionmentioning

confidence: 99%

Outcomes in Economic Evaluations of Public Health Interventions in Low‐ and Middle‐Income Countries: Health, Capabilities and Subjective Wellbeing

2016

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Public health programmes tend to be complex and may combine social strategies with aspects of empowerment, capacity building and knowledge across sectors. The nature of the programmes means that some effects are likely to occur outside the healthcare sector; this breadth impacts on the choice of health and non‐health outcomes to measure and value in an economic evaluation.Employing conventional outcome measures in evaluations of public health has been questioned. There are concerns that such measures are too narrow, overlook important dimensions of programme effect and, thus, lead to such interventions being undervalued. This issue is of particular importance for low‐income and middle‐income countries, which face considerable budget constraints, yet deliver a large proportion of health activities within public health programmes.The need to develop outcome measures, which include broader measures of quality of life, has given impetus to the development of a variety of new, holistic approaches, including Sen's capability framework and measures of subjective wellbeing. Despite their promise, these approaches have not yet been widely applied, perhaps because they present significant methodological challenges. This paper outlines the methodological challenges for the identification and measurement of broader outcomes of public health interventions in economic evaluation in low‐income and middle‐income countries.

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“…Understanding how chronic conditions affect QOL, particularly across different cultural contexts and regions might help to evaluate the relative impact of chronic conditions, prioritize conditions within limited-resources sites, and design site-specific interventions to improve QOL across different contexts [ 18 ]. To date, the majority of studies assessing the association between chronic conditions and QOL have been conducted in urban areas, and we could not find studies exploring how urbanization modifies the chronic condition-QOL association.…”

Section: Introductionmentioning

confidence: 99%

Association between chronic conditions and health-related quality of life: differences by level of urbanization in Peru

et al. 2017

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PurposeTo evaluate the role of urbanization as an effect modifier for the association between specific chronic conditions and number of conditions with health-related quality of life (QOL).MethodsWe analyzed cross-sectional data from the CRONICAS Cohort Study conducted in Lima (highly urbanized), Tumbes (semi-urban), as well as rural and urban sites in Puno. Exposures of interest were chronic bronchitis, depressive mood, hypertension, type 2 diabetes, and a composite variable aggregating the number of chronic conditions (the four exposures plus heart disease and stroke). QOL outcomes were assessed with EuroQol’s EQ-5D visual analogue scale (EQ-VAS). We fitted linear regressions with robust variance to evaluate the associations of interest. Study site was assessed as a potential effect modifier using the likelihood-ratio (LR) test.ResultsWe evaluated data on 2433 subjects: 51.3% were female, mean age was 57.2 years. Study site was found to be an effect modifier only for the association between depressive mood and EQ-VAS score (LR test p < 0.001). Compared to those without depressive mood, participants with depressive mood scored −13.7 points on the EQ-VAS in Lima, −7.9 in urban Puno, −11.0 in semi-urban Tumbes, and −2.7 in rural Puno. Study site was not found to be an effect modifier for the association between the number of chronic conditions and EQ-VAS (LR test p = 0.64).ConclusionThe impact of depressive mood on EQ-VAS was larger in urban than in rural sites, while site was not an effect modifier for the remaining associations.Electronic supplementary materialThe online version of this article (doi:10.1007/s11136-017-1649-7) contains supplementary material, which is available to authorized users.

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The evolution of the disability-adjusted life year (DALY)

Cited by 68 publications

References 34 publications

The allocation of US$105 billion in global funding from G20 countries for infectious disease research between 2000 and 2017: a content analysis of investments

The allocation of US$105 billion in global funding from G20 countries for infectious disease research between 2000 and 2017: a content analysis of investments

Outcomes in Economic Evaluations of Public Health Interventions in Low‐ and Middle‐Income Countries: Health, Capabilities and Subjective Wellbeing

Association between chronic conditions and health-related quality of life: differences by level of urbanization in Peru

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