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Unformatted text preview: Annu. Rev. Public Health 2002. 23:115–34 DOI: 10.1146/annurev.publhealth.23.100901.140513 Copyright c 2002 by Annual Reviews. All rights reserved HALY S AND QALY S AND DALY S , O H M Y : Similarities and Differences in Summary Measures of Population Health Marthe R. Gold 1 , David Stevenson 2 , and Dennis G. Fryback 3 1 Department of Community Health and Social Medicine, City University of New York Medical School, 138th Street and Convent Avenue, New York, New York 10031; e-mail: [email protected] 2 Program in Health Policy, Harvard University, Cambridge, Massachusetts 02138; e-mail: [email protected] 3 Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin 53705-2397; e-mail: [email protected] Key Words burden of disease, cost-effectiveness analysis, health-related quality of life ■ Abstract Health-adjusted life years (HALYs) are population health measures per- mitting morbidity and mortality to be simultaneously described within a single number. They are useful for overall estimates of burden of disease, comparisons of the relative impact of specific illnesses and conditions on communities, and in economic analyses. Quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs) are types of HALYs whose original purposes were at variance. Their growing importance and the varied uptake of the methodology by different U.S. and international entities makes it useful to understand their differences as well as their similarities. A brief history of both measures is presented and methods for calculating them are reviewed. Methodological and ethical issues that have been raised in association with HALYs more generally are presented. Finally, we raise concerns about the practice of using different types of HALYs within different decision-making contexts and urge action that builds and clarifies this useful measurement field. INTRODUCTION Health has long been evaluated by mortality-based indicators, both in the United States and internationally. Life expectancy, all-cause and disease-specific mortal- ity, and infant mortality are compared by region, by nation, and across nations. Death rates and life expectancies are disaggregated and presented by sociode- mographic and ethnic descriptors in efforts to evaluate population health and, at times, to monitor the impact of health interventions. Although mortality-based rates are useful in a cursory way, they provide insufficient information with which 0163-7525/02/0510-0115$14.00 115 A n n u . R e v . P u b l i c . H e a l t h . 2 2 . 2 3 : 1 1 5- 1 3 4 . D o w n l o a d e d f r o m a r j o u r n a l s . a n n u a l r e v i e w s . o r g b y R u t g e r s U n i v e r s i t y L i b r a r i e s o n 6 / 2 / 6 . F o r p e r s o n a l u s e o n l y . 116 GOLD ¥ STEVENSON ¥ FRYBACK to make any but the most basic judgments about the health of a population or the comparative impact of an intervention. The contribution of chronic disease, injury,comparative impact of an intervention....
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- Demography, Life expectancy, DALYs