Disability adjusted life years

DALYs
Dr Enas Aboraya
 What is Disability adjusted life years
(DALYs) lost

The DALYs lost expresses years

of life lost due to premature

death and years lived with a

disability of specific severity

and duration
 DALYs
• One DALY lost is thus one lost year of healthy
life. So to calculate total DALYs for a given
condition in a population, years of life lost
(YLLs) by deaths and years lived with
disability of known severity and duration
(YLDs) for that condition must be estimated
and then the total summed
QOL is a quantitative measure for burden of
diseases.
Burden of diseases

Health outcome

Physical Psychosocial

DALYs QOL
The world bank landmark study, investing in
health, proposed that the planning and
development of health services should be
based on burden of disease and cost
effectiveness analysis.
World development report (1993)
 Four possible outcomes following the onset of
disease:
• Immediate or premature death.
• Death following a period of disability.
• Premature disability.
• Recovery from the disease following acute illness.
For estimation of the disability adjusted life years lost the following figures
are required for its calculation:

• incidence rate.
• Case fatality rate
• Proportion of individuals who are temporarily disabled prior to death.
• Proportion of individuals permanently disabled.
• Degree of disablement.
• Average duration of acute disease.
• Average age of onset of disease (AO) and age of death (Ad).
• Life expectancy at age of death E (Ad) and age of onset of disease E (Ao).
 Why DALYs……It’s Benefit.
• The methodology could be used to help
determine the priorities for the allocation of
resources to alternative health improvement
procedures by estimating the number of
healthy days of life, which are likely to be
saved by different procedures and by relating
these saving to the costs of the procedures
Estimating The Impact Of Intervention On Burden Of
Disease
• To calculate the number of DALYs gained from
health intervention, we had to have an estimate of
the impact of the intervention on reducing disease
burden.
• Effectiveness of some interventions may be known
in a qualitative way (e.g. high or low) but a limited
amount of quantitative information exists on the
impact of many interventions.
 Possible Health Outputs
• PHC: consultations, Immunization coverage.
• Secondary care: surgeries, bed days, etc.
• Tertiary care: disability rate and degree.
• NB: these generally reflect intermediate
outcomes, production of health services,
necessary to achieve end outcome, improved
health
 Common health Outcomes
• Infant mortality rate
• child mortality rate
• Maternal mortality rate
• Life Expectancy
• Healthy life years gained
 Child immunization
Costs? Consequences

Inputs Process Outputs Outcomes

•Training •Children •Reduction in

•Vaccines
•Community immunized child
•Personnel mortality/morbi
awareness •Fully
•Vaccine dity
•Outreach Immunized
carriers visits Children (FICs)
•Vehicles •Clinic Visits
•Supervision
• Effectiveness (%) = Efficacy (%) X Diagnostic
accuracy (%) X health providers compliance
(%) X patient compliance (%)
• Coverage (%) = Accessibility (%) X
Acceptability (%)
• Impact (%) = Effectiveness (%) X Coverage (%)
• Community effectiveness is the impact of a health
program on the over all death rate in the community. It
can be expressed in one of two ways .
– The ratio death risk in the intervention group
to that in the control group expresses relative
risk (RR)
– The number of deaths averted as a result of
the intervention (attributable risk) is
measured by the difference in risk between
the two groups.
• Community and individual effectiveness are
not equivalent, unless the intervention
coverage is 100%.
• Community effectiveness = individual
effectiveness X Coverage
• measuring improvements in the quality of life
is important as well as gains in the length of
life. Also important are the cost required to
achieve gains from health care interventions
and the difficulty that providers have in
prescribing and patients have in complying
with these interventions
A gain in life expectancy from a medical
intervention can be categorized as large or
small by comparing it with gains from other
interventions aimed at the same target
population.
 Calculating Number Of Healthy Life Years Or
Dalys Gained:
• For example, assume that an immunization
program can achieve a 50% coverage rate
within a year, and the incidence of measles
without vaccination is approximately
39/1000. Vaccine efficacy is estimated to be
95%. A 47.5% reduction in the incidence rate
can be attained through the program (95% x
50%).
• Effectiveness = Coverage X Effecacy of the
vaccine.
• The new incidence rate would be 39/1000
multiplied by (100%-47.5%) .
• This figure is used to recalculate the DALYs
lost per 1000 population with the health
intervention using the formulas previously
mentioned.
• The difference between this recalculated
DALYs lost and the original DALYs lost by the
disease without the intervention is called the
DALYs gained
 Why assessing the burden?
No country in the world can provide health services to
meet all the possible needs of the population, so it is
advisable to establish criteria for which services to be
provided, two basic criteria are the size of the burden
caused by a particular disease, injury or risk factor and the
with it cost effectiveness of interventions to deal
 Global efforts in QOL assessment and
concern
• Ghana Health Assessment project,1981
• The Global burden of disease (GBD) is an
international project started its first phase
1990-2000 and second phase 2000-2010
• The European quality of life research ( Euro
QOL)2003
• The Human Development project 2007
 The Global burden of disease
• GBD were measured by combining (a) losses
from premature death, which is defined as
the difference between actual age at death
and life expectancy at that age in a low
mortality population, and (B) loss of health
life resulting from disability
Causes of disabilities and deaths were classified into
three broad causes groups:

• Group I: communicable, maternal, perinatal

and nutritional conditions.
• Group II: Non communicable.
• Group III: Injuries and poisonings.
 Formulas for Cost Calculations
• Economic costs are calculated as the product
of the quantity inputs, the percent use for a
specific health intervention, and the unit cost
of the input. However, it may be simpler in
some cases to rely on records of
expenditures.
 Cost effectiveness Analysis
Evaluating the cost effectiveness of health
interventions can be assessed by dividing the
total cost by the number of DALYs gained to
estimate the average cost per DALY.
Interventions with the lowest average cost
are presumed to be the cost effective
strategies
Once cost-effectiveness ratios are calculated for each
intervention, they can be ranked from the most, to the least
cost effective (largest ratio), since health care priorities may
not be based on economic criteria alone, some formats
allows for a qualitative evaluation (e.g. high, medium and
low) of the acceptability of the intervention to the
population; the affordability of services and the feasibility of
implementation
 One of the main conclusions of the World
Bank’s World Development Report, (1993),

was that equitable access to a package of essential

clinical and public health services could significantly
reduce the overall burden of disease in low income
countries. The report also, postulated that the
provision of essential clinical services and public
health interventions to 80% of the population would
bring about 32% reduction in the burden of disease
in those countries.
Thank you