Elsevier

Journal of Health Economics

Volume 16, Issue 6, December 1997, Pages 685-702
Journal of Health Economics

Symposium on DALYs
Disability-adjusted life years: a critical review

https://doi.org/10.1016/S0167-6296(97)00005-2Get rights and content

Abstract

The disability-adjusted life year (DALY) has emerged in the international health policy lexicon as a new measure of the ‘burden of disease’. We argue that the conceptual and technical basis for DALYs is flawed, and its assumptions and value judgements are open to serious question. In particular, the implications of age-weighting and discounting are found to be unacceptable. Moreover, the proponents of DALYs do not distinguish between the exercises of measuring the burden of disease and of allocating resources. But the appropriate information sets for the two exercises are quite different. Allocating resources by aggregate DALY-minimization is shown to be inequitable.

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Anand's research was supported by the John D. and Catherine T. MacArthur Foundation, and by the Institute of Economics and Statistics, Oxford. We are extremely grateful to Ramesh Govindaraj, who was involved in the early stages of this project and provided valuable substantive and editorial comments. For helpful comments or discussion, we are also very grateful to Lincoln Chen, Roger Crisp, William Hsiao, Jonathan Levin, Michael Lockwood, Sanjay Reddy, Michael Reich, Dan Robinson, Amartya Sen and Devinder Sivia.

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