Fox-Rushby J A, Hanson K
Health Economics and Financing Programme, Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK.
Health Policy Plan. 2001 Sep;16(3):326-31. doi: 10.1093/heapol/16.3.326.
Disability adjusted life years (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 and intensity) of any mental or physical disability caused by a disease or injury. They have been used as an outcome indicator in micro economic evaluations as well as sectoral prioritization exercises using league tables of cost-effectiveness. However, many of the current analyses are not comparable or transferable because either the assumptions used differ or are unclear, and because results are not presented in a way that allows researchers or policy-makers to re-calculate and re-interpret findings for use in an alternative context. However, at times there have also been miscalculations. This may happen either because evaluators disagree with the assumptions behind DALYs or because the methods of calculation have not been set out clearly. This paper shows how to calculate DALYs for cost-effectiveness analysis using a worked example. It also shows the impact of changing the age weighting and discount rates on estimates of cost-effectiveness, and suggests a set of minimum reporting criteria for using DALYs in cost-effectiveness analysis. Finally, readers are introduced briefly to a selected literature arguing for and against the use of DALYs.
伤残调整生命年（DALYs）是因过早死亡而损失的未来寿命年数的现值与因疾病或损伤导致的任何精神或身体残疾的平均严重程度（频率和强度）而调整的未来寿命年数的现值之和。它们已被用作微观经济评估以及使用成本效益排行榜进行部门优先排序的结果指标。然而，当前的许多分析不可比或不可转移，原因要么是所采用的假设不同或不明确，要么是结果呈现方式不允许研究人员或政策制定者重新计算和重新解释结果以用于其他背景。然而，有时也会出现计算错误。这可能是因为评估人员不同意DALYs背后的假设，或者是因为计算方法没有明确列出。本文通过一个实例展示了如何计算用于成本效益分析的DALYs。它还展示了改变年龄权重和贴现率对成本效益估计的影响，并提出了一套在成本效益分析中使用DALYs的最低报告标准。最后，简要介绍了一些支持和反对使用DALYs的文献供读者参考。
