London School of Economics and Political Science, London, UK.
Health Econ. 2009 Nov;18(11):1237-47. doi: 10.1002/hec.1424.
This paper focuses on the contrast between describing the benefit of a healthcare intervention as gain in health (QALY-type ideas) or a disability reduction (DALY-type ideas). The background is an apparent convergence in practice of the work conducted under both traditions. In the light of these methodological developments, we contrast a health planner who wants to maximise health and one who wants to minimise disability. To isolate the effect of framing the problem from a health or a disability perspective, we do not use age-weighting in calculating DALY and employ a common discounting methodology and the same set of quality of life weights. We find that interventions will be ranked in a systematically different way. The difference, however, is not determined by the use of a health or a disability perspective but by the use of life expectancy tables to determine the years of life lost. We show that this feature of the DALY method is problematic and we suggest its dismissal in favour of a fixed reference age rendering the use of a health or a disability perspective merely stylistic.
本文关注的是将医疗干预的益处描述为健康增益（QALY 类理念）或残疾减少（DALY 类理念）之间的对比。其背景是两种传统下开展的工作在实践中明显趋同。鉴于这些方法学的发展，我们对比了想要最大化健康的卫生规划者和想要最小化残疾的卫生规划者。为了将问题从健康或残疾的角度进行框架隔离，我们在计算 DALY 时不使用年龄加权，并采用通用的贴现方法和相同的一套生活质量权重。我们发现干预措施的排序将系统地有所不同。然而，这种差异不是由健康或残疾的角度决定的，而是由使用预期寿命表来确定丧失的生命年数决定的。我们表明，DALY 方法的这一特征存在问题，我们建议摒弃该方法，转而采用固定参考年龄，从而使健康或残疾视角的使用仅仅具有风格上的意义。
