临床经济学评价(2009.11).ppt

The Global Burden of Diseases Exercise done jointly by the WHO and the WB to identify the diseases having the highest burden on the World (WDR 1993）。 They have used a measure easier than QALYs: international DALYs (Disability Adjusted Life Years). Application to 107 health disorders, distinction per continent and gender. A few figures (WHO 2000) Total lost DALYs in 1999:1438 bilions. 66% of DALYs are lost because of a premature death, 34 % because of individuals. Diarrhoea + childhood perinatal diseases + malaria + RTI = 26.1% Africa (10% of world population): 26 % of lost DALY s. Measuring gains QALYs and DALYs are different mathematical transformations measuring health outcome. They combine the change in quality of life and the change in life expectancy caused by an intervention, Suppose a medicine allows a patient to live 5 more years but only in a state of health that is considered half as good as a perfect health. Then the gain is 5 *5 = 2.5 QALEs Cost Utility Analysis For a given intervention, it is then possible to assess the specific health benefit. It is possible to compare different interventions, tackling same diseases or very different ones. Compare effectiveness Compare efficiency (=CUA) Exercise A €10,000 investment in program K generates a gain of 532 QALYs. Cost-Utility of K: €18.8/saved QALY A €23,000 IN PROGRAM l YIELDS A GAIN OF 1,687 QALYs. Cost-Utility of L: €13.6/ saved QALY. If the budget is limited to €25,000, the best option is … DALYs QALYs is a technique too complex for developing countries. = need for something more pragramtic for priority setting in DC settings. DALYs have been developed as a joint effort by Harvard, the World Bank and the WHO. How to calculate DALYs? DALYs are the sum of the present value of future years of lifetime lost through premature mortality, and the present value of years of future lifetime adjusted for the average severity (frequency intensity) of any mental or physical disability caused by a disease or i