Asymmetries of poverty: why global burden of disease valuations underestimate the burden of neglected tropical diseases.
Asymmetries of poverty: why global burden of disease valuations underestimate the burden of neglected tropical diseases.
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DOI：
10.1371/journal.pntd.0000209
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发表时间：
2008-03-26
影响因子：
3.8
通讯作者：
Bertino AM
中科院分区：
文献类型：
--
作者：
King CH;Bertino AM
残疾调整生命年（DALY）最初在全球疾病负担（GBD）计划中作为一个健康指标显得很有吸引力，因为它声称是一个全面的健康评估，包括过早死亡率，发病率，损伤和残疾。最初认为DALY在政策制定中很有用，反映了作为健康状况标准化单位的规范性评估。然而，DALY的设计及其在政策估计中的使用存在固有缺陷，导致系统性低估了慢性病（例如许多被忽视的热带病（NTD））在世界健康中的重要性。DALY的概念设计主要侧重于个人风险，而不是疾病的生态学，因此没有认识到背景对穷人疾病负担的影响。它不能代表贫困对残疾的影响，这导致严重低估了慢性疾病，如NTD的残疾权重。最后，DALY在政策估计中的应用没有考虑到贫困在疾病控制成本-效用分析中的非线性影响，有效地降低了综合治疗NTD的效用。如果GBD要成为确定卫生优先事项的有效和有用的系统，就需要对目前的DALY框架进行实质性修订。
The disability-adjusted life year (DALY) initially appeared attractive as a health metric in the Global Burden of Disease (GBD) program, as it purports to be a comprehensive health assessment that encompassed premature mortality, morbidity, impairment, and disability. It was originally thought that the DALY would be useful in policy settings, reflecting normative valuations as a standardized unit of ill health. However, the design of the DALY and its use in policy estimates contain inherent flaws that result in systematic undervaluation of the importance of chronic diseases, such as many of the neglected tropical diseases (NTDs), in world health. The conceptual design of the DALY comes out of a perspective largely focused on the individual risk rather than the ecology of disease, thus failing to acknowledge the implications of context on the burden of disease for the poor. It is nonrepresentative of the impact of poverty on disability, which results in the significant underestimation of disability weights for chronic diseases such as the NTDs. Finally, the application of the DALY in policy estimates does not account for the nonlinear effects of poverty in the cost-utility analysis of disease control, effectively discounting the utility of comprehensively treating NTDs. The present DALY framework needs to be substantially revised if the GBD is to become a valid and useful system for determining health priorities.
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DOI：
10.4269/ajtmh.1995.53.660
发表时间：
1995-12-01
影响因子：
3.3
作者：
Guyatt, H;Gryseels, B;Tanner, M
通讯作者：
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影响因子：
3.8
作者：
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通讯作者：
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DOI：
10.1007/s10198-001-0090-5
发表时间：
2002-01-01
期刊：
The European journal of health economics : HEPAC : health economics in prevention and care
影响因子：
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作者：
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通讯作者：
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DOI：
10.1016/j.trstmh.2005.03.014
发表时间：
2006-03-01
影响因子：
2.2
作者：
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通讯作者：
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影响因子：
3.3
作者：
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通讯作者：
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